Indicators of acute renal-transplant rejection in patients treated with cyclosporine

1990 ◽  
Vol 36 (5) ◽  
pp. 759-764 ◽  
Author(s):  
P W Mueller ◽  
V Delaney ◽  
M L MacNeil ◽  
S P Caudill ◽  
K K Steinberg
Keyword(s):  
Renal Transplant ◽  
Sensitivity And Specificity ◽  
Activity Ratio ◽  
Transplant Rejection ◽  
Plasma Creatinine ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Alanine Aminopeptidase ◽  
Optimal Values ◽  
Renal Transplant Rejection

Abstract We evaluated the ability of three enzymes--N-acetyl-beta-D-glucosaminidase (NAG; EC 3.2.1.30), alanine aminopeptidase (AAP; microsomal aminopeptidase, EC 3.4.11.2), and gamma-glutamyltransferase (GGT; EC 2.3.2.2)--and adenosine deaminase binding protein (ABP) in urine to predict or confirm renal-transplant rejection in patients treated with cyclosporine. We measured the enzymes daily during the early post-transplant hospital stay of 104 renal-transplant recipients (72 men and 32 women). We also measured ABP in 32 of these patients. We analyzed the data by calculating the activity ratio of each day's test value to the previous day's result and optimized the sensitivity (SN) and specificity (SP) to determine the optimal ratio for each test. The results indicate that cyclosporine treatment reduces the optimal sensitivity and specificity of these tests. Three comparable tests (ABP, GGT, and AAP) yield the best optimal values (SN = 0.77, 0.69, 0.77; and SP = 0.71, 0.74, 0.63, respectively), and the NAG test yields the lowest combination of sensitivity and specificity (SN = 0.62, SP = 0.66). All four tests were less sensitive and specific than the plasma creatinine test (optimal day-to-day difference = 5 mg/L). However, the ABP and AAP tests gave indications of rejection at least 24 h before clinical diagnosis for 50% of the patients experiencing rejection, while early plasma creatinine increases of 5 mg/L occurred in only 19% of this group.

Clinically Significant Drug−Drug Interaction Between Tacrolimus and Phenobarbital

2010 ◽  
Vol 23 (6) ◽  
pp. 585-589 ◽  
Author(s):  
Nida Siddiqi ◽  
Kwaku Marfo
Keyword(s):  
Drug Interaction ◽  
Renal Transplant ◽  
Drug Interactions ◽  
Transplant Rejection ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Patient Identification ◽  
Clinically Significant ◽  
Trough Levels ◽  
Renal Transplant Rejection

Purpose: The case of a 57-year-old male who experienced acute renal transplant rejection due to subtherapeutic tacrolimus levels as a result of drug interaction with phenobarbital. Summary: Drug interactions with tacrolimus due to its metabolism through the CYP 450 3A4 enzymatic pathway have led to several reports of altered tacrolimus levels, which can lead to acute rejection in renal transplant recipients. We describe the case of a 57-year-old male initiated on immunosuppressive therapy with tacrolimus in addition to his anticonvulsant medications. Conclusion: Upon tacrolimus dose increases, discontinuation of carbamazepine, and minimization of phenobarbital dose, effective tacrolimus trough levels were achieved in our patient. Identification and elimination of such drug−drug interactions is necessary to assure adequate immunosuppression in renal transplant recipients.

Sulphinpyrazone Does Not Influence Rejection Of Renal Transplants

1981 ◽  
Author(s):  
J H Turney ◽  
M Bewick ◽  
M J Weston
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Transplant Rejection ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Fibrin Deposition ◽  
Chi Squared ◽  
And Function ◽  
To Receive ◽  
Renal Transplant Rejection

Platelet-mediated intravascular fibrin deposition may be the distal arm of the transplant rejection process. There have been reports that anti pi ate let drugs may prevent ameliorate, or even reverse renal transplant rejection. 50 consecutive cadaveric renal transplant recipients were randomly allocated to receive sulphinpyrazone 400 mg twice daily or no treatment additional to conventional immunosuppressive therapy. Patients were followed for 6 months, at which time they were assessed for graft survival and function, and for the number of rejection episodes. Rejection was defined as a rise in serum creatinine for which no other explanation was identified. Results were analysed by the Chi-squared test with Yates’ correction. Results at 6 months: There were no differences between the two groups, neither did the function of the surviving grafts differ.We conclude that, in this study, antiplatelet therapy with sulphinpyrazone does not affect the outcome of cadaveric renal transplantation.

scholarly journals Chemokine Receptor Polymorphism and Risk of Acute Rejection in Human Renal Transplantation

2002 ◽  
Vol 13 (3) ◽  
pp. 754-758 ◽  
Author(s):  
Reza Abdi ◽  
Tran Thi Bich Huong ◽  
Alfredo Sahagun-Ruiz ◽  
Philip M. Murphy ◽  
Barry M. Brenner ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Chemokine Receptor ◽  
Chemokine Receptors ◽  
Renal Allograft ◽  
Transplant Rejection ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Renal Transplant Rejection

ABSTRACT. Chemokines regulate the trafficking of leukocytes in immunity and inflammation and have been implicated in mouse models in acute cardiac and renal allograft rejection; however, their significance to human transplantation is not yet defined. The association of human chemokine receptor genetic variants, CCR5-Δ32, CCR5-59029-A/G, CCR2-V64I, CX3CR1-V249I, and CX3CR1-T280M, with outcome in 163 renal transplant recipients was examined here. Significant reductions were found in risk of acute renal transplant rejection in recipients who possessed the CCR2-64I allele (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.12 to 0.78; P = 0.014) or who were homozygous for the 59029-A allele (OR, 0.37; 95% CI, 0.16 to 0.85; P = 0.016). There were no significant differences in the incidence of rejection among patients stratified as with or without CCR5-Δ32 or by the CX3CR1-V249I or CX3CR1-T280M genotypes. Adjustment for known risk factors for transplant rejection confirmed the univariate findings for possession of the CCR2-64I allele (OR, 0.20; P = 0.032) and homozygosity for the 59029-A allele (OR, 0.26; P = 0.027). It was concluded that the risk of acute rejection in renal transplantation is associated with genetic variation in the chemokine receptors CCR2 and CCR5.

Diagnostic significance of some urinary enzymes for detecting acute rejection crises in renal-transplant recipients: alanine aminopeptidase, alkaline phosphatase, gamma-glutamyltransferase, N-acetyl-beta-D-glucosaminidase, and lysozyme.

1986 ◽  
Vol 32 (10) ◽  
pp. 1807-1811 ◽  
Author(s):  
K Jung ◽  
J Diego ◽  
V Strobelt ◽  
D Scholz ◽  
G Schreiber
Keyword(s):  
Alkaline Phosphatase ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Urinary Enzymes ◽  
Gamma Glutamyltransferase ◽  
Alanine Aminopeptidase ◽  
Group A ◽  
Group B

Abstract We compared the diagnostic validity of five urinary enzymes--alanine aminopeptidase (EC 3.4.11.2), alkaline phosphatase (EC 3.1.3.1), gamma-glutamyltransferase (EC 2.3.2.2), N-acetyl-beta-D-glucosaminidase (EC 3.2.1.30), and lysozyme (EC 3.2.1.17)--as indicators of acute rejection crises in renal-transplant recipients. In 82 patients (group A), the excretion of each of these five enzymes was measured daily from transplantation until discharge from hospital. In another 69 patients (group B), enzyme determinations were made when the patient came for regular checkups (about every four to eight weeks). We used an "activity ratio" (the activity measured at a particular time compared with the activity on the preceding determination) value of 1.5 as the decision point. In group A, use of this discrimination point for alanine aminopeptidase, gamma-glutamyltransferase, and N-acetyl-beta-D-glucosaminidase yielded a specificity and sensitivity of about 90%. In group B, only alanine aminopeptidase had a greater diagnostic sensitivity than creatinine alone. Evidently, measurement of alanine aminopeptidase can be a helpful indicator of acute rejection crises, when interpreted in combination with other available relevant clinical, biochemical, and immunological data.

Urinary enzyme excretion by renal-transplant recipients in relation to interval after transplantation.

1982 ◽  
Vol 28 (8) ◽  
pp. 1762-1764 ◽  
Author(s):  
K Jung ◽  
J Diego ◽  
D Scholz ◽  
K Schröder ◽  
V Strobelt
Keyword(s):  
Renal Transplant ◽  
Reference Group ◽  
Transplant Rejection ◽  
Early Period ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Renal Disorder ◽  
Urinary Enzyme ◽  
Daily Dose ◽  
Urinary Enzyme Excretion

Abstract We determined the urinary excretion of the enzymes aminopeptidase (EC 3.4.11.2), alkaline phosphatase (EC 3.1.3.1), gamma-glutamyltransferase (EC 2.3.2.2), and N-acetyl-beta-glucosaminidase (EC 3.2.1.30) in two groups of renal-transplant recipients at different times after transplantation (1.8 months and 52 months, respectively). Both groups of patients showed a higher rate of enzyme excretion than did a reference group of healthy persons. More aminopeptidase and N-acetyl-beta-glucosaminidase were excreted during the early period after transplantation than later. The time-dependence of urinary enzyme excretion was confirmed in six renal-transplant recipients studied during the course of 15 months after transplantation. There was a general correlation between the extent of urinary enzyme excretion and both the time after transplantation and the daily dose of prednisolone. Therefore, it is necessary to take into account this influence on the extent of urinary enzyme in renal-transplant recipients if urinary enzyme excretion is used as an indicator of renal disorder and especially as an early predictor of transplant rejection.

scholarly journals THE VALUE OF EXTRACORPOREAL PHOTOCHEMOTHERAPY IN RENAL TRANSPLANT REJECTION INHIBITION

2016 ◽  
Vol 18 (2) ◽  
pp. 46-55
Author(s):  
V. A. Fedulkina ◽  
A. V. Vatazin ◽  
A. V. Kildyushevsky ◽  
A. Ya. Olshansky ◽  
A. P. Faenko
Keyword(s):  
Renal Transplant ◽  
Transplant Rejection ◽  
Receptor Activation ◽  
Early Postoperative Period ◽  
Control Group ◽  
Study Group ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Control Groups ◽  
Extracorporeal Photochemotherapy

The aim of the study was to determine the value of extracorporeal photochemotherapy (EPCT) in the induction of tissue tolerance in renal transplantation. EPCT was applied to 24 renal transplant recipients in early postoperative period, the control group consisted of paired transplant recipients. In the group using EPCT over a three-year period of observation no clinical or histological signs of rejection were observed. In the control group, histologically confirmed rejection was observed in 4 cases, in 2 cases transplantectomy due to acute rejection. The reducing incidence of infectious complications in the study group compared with the control one (4 and 19 cases, respectively) and decreasing number of hospitalizations on various reasons (8 and 47 cases in the study and control groups, respectively) were also noted. Three-year graft survival was 100% and 83.3% in the study and the control groups, respectively. Using immunological tests in 30 days after transplantation the stable number of cells expressing coactivation molecules (57.7 ± 18.2 and 52.7 ± 23.2%, respectively, p > 0.05) and the density of their co-expression (22.7 ± 6.0 and 19.6 ± 7.0 units, respectively, p > 0.05) were demonstrated, while in the study group, the pronounced and statistically significant reduction both in the amount of cells expressing co-activation receptors (from 57.7 ± 18.2 to 34.5 ± 11.4%, p < 0.05) and in the density of these receptors on naive helper T-lymphocytes (from 22.7 ± 6.0 to 16.8 ± 5.1 units, p < 0.05) was revealed. Thus, it is noted that EPCT provides induction of tolerance to MHC antigens in kidney transplantation due to reducing expression of coactivation molecules which promote the second signaling pathway to T-cell receptor activation. 

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