scholarly journals Short and Long-Term Follow up Results of Daily 5 Mg Tadalafil as a Treatment for Erectile Dysfunction and Premature Ejaculation

2021 ◽  
Author(s):  
Tarek Gharib ◽  
Ibrahim Abdelal ◽  
Adel Elatreisy ◽  
Elsayed Salih ◽  
Ahmed Sebaey
Keyword(s):  
Erectile Dysfunction ◽  
Premature Ejaculation ◽  
P Value ◽  
Group I ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
The Mean ◽  
Group Ii

Abstract Objective: To evaluate effectiveness and safety of a 5mg tadalafil daily treatment for men with erectile dysfunction (ED) and premature ejaculation (PE) and assessment of long-term follow up by persistence of improvement 2 years after stoppage of tadalafil.Materials and Methods: The study included 160 patients diagnosed with erectile dysfunction from April 2018 to June 2020. All were evaluated using the international index of erectile function questionnaire-5 (IIEF-5) to evaluate ED and intravaginal ejaculatory latency time (IELT) for PE. Patients subdivided into two equal groups. I included 80 patients treated with tadalafil 5 mg daily for 3 months, and group II included 80 patients treated with a placebo for same period. After 3 months treatment and 2 years later after stoppage of tadalafil, all patients were assessed for ED and PE using the same questionnaires. Results: The mean IELT and IIEF pretreatment were 37±11.24 s and 13.2±4.2 respectively for group I, while in group II was 35.98±10.8 s and 13.12±4.11, respectively. After 3 months of treatment, the mean value of IELT in group I showed a highly significant improvement from 37±11.24 sec to 120.5±47.37 sec (p-value < 0.001), but for group II, the mean values of IELT showed no significant improvement from baseline 35.98±10.8 to endpoint 39.43±13.6 ( p-value > 0.05). As regarding the IIEF, there was a highly significant improvement from baseline 13.2±4.2 to endpoint 20.45±4.5 in group I (p-value < 0.001) while there was no significant difference in group II from baseline 13.12±4.11 to endpoint 15±4.84 (p-value > 0.05) . 2 years later after stoppage of tadalafil , 75 patients from group I complete follow up and there was significant improvement in IELT and IIEF form base line (37±11.24) (13.2±4.2) to endpoint (98±18.3) (19.1±2.3) respectively but less than the results after 3 months treatment.ConclusionDaily Tadalafil 5 mg was effective, tolerable, and safe treatment for patients suffering from ED and PE. Long-term follow up after 2 years declared persistence of significant improvement.

scholarly journals Long-term follow-up of therapeutic efficacy of everolimus-eluting bioresorbable vascular scaffold in comparison to everolimus-eluting stent in treatment of chronic total occlusion guided by intracoronary imaging

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Mohammad Abdallah Eltahlawi ◽  
Abdel-Aziz Fouad Abdel-Aziz ◽  
Abdel-Salam Sherif ◽  
Khalid Abdel-Azeem Shokry ◽  
Islam Elsayed Shehata
Keyword(s):  
Chronic Total Occlusion ◽  
Bioresorbable Vascular Scaffold ◽  
Total Occlusion ◽  
Intracoronary Imaging ◽  
Group I ◽  
Significant Difference ◽  
Vascular Scaffold ◽  
Long Term Follow Up

Abstract Background We hypothesized that 1st generation everolimus-eluting bioresorbable vascular scaffold (BVS) stent associated with less complication and less restenosis rate than everolimus-eluting stent (EES) in chronic total occlusion (CTO) recanalization guided by intracoronary imaging. Therefore, we aimed to assess the safety and performance of BVS stent in CTO revascularization in comparison to EES guided by intracoronary imaging. Our prospective comparative cross-sectional study was conducted on 60 CTO patients divided into two groups according to type of stent revascularization: group I (EES group): 40 (66.7%) patients and group II (BVS group): 20 (33.3%) patients. All patients were subjected to history taking, electrocardiogram (ECG), echocardiography, laboratory investigation, stress thallium study to assess viability before revascularization. Revascularization of viable CTO lesion guided by intracoronary imaging using optical coherence tomography (OCT). Then, long-term follow-up over 1 year clinically and by multi-slice CT coronary angiography (MSCT). Our clinical and angiographic endpoints were to detect any clinical or angiographic complications during the follow-up period. Results At 6 months angiographic follow-up, BVS group had not inferior angiographic parameters but without statistically significant difference (p = 0.566). At 12 months follow-up, there was no difference at end points between the two groups (p = 0.476). No differences were found at angiographic or clinical follow-up between BVS and EES. Conclusion This study shows that 1st generation everolimus-eluting BVS is non-inferior to EES for CTO revascularization. Further studies are needed to clearly state which new smaller footprint BVS, faster reabsorption, magnesium-based less thrombogenicity, and advanced mechanical properties is under development. We cannot dismiss the efficacy and safety of new BVS technology. Trial registration ZU-IRB#2498/3-12-2016 Registered 3 December 2016, email: [email protected]

Partial Splenic Embolization UsingBletilla striataParticles for Hypersplenism in Cirrhosis: A Prospective Study

2011 ◽  
Vol 39 (02) ◽  
pp. 261-269 ◽  
Author(s):  
Rong Liu ◽  
Xiao-Jun Teng ◽  
Jiang-Fu He ◽  
Shao-Shu Xiao ◽  
Zhi-Bing Yuan ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Esophageal Varices ◽  
Embolic Material ◽  
Cell Counts ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Bleeding Episodes ◽  
The Mean

The article evaluates the long-term follow-up results of PSE using Bletilla striata (BS) particles for hypersplenism in cirrhosis, as compared to PSE using gelfoam particles. Fifty-nine patients with cirrhosis-induced hypersplenism were treated with PSE. The patients were randomly assigned into two groups: gelfoam group, which includes 32 patients using gelfoam particles as the embolic material, and BS group, which includes 27 patients using BS particles. The peripheral blood cell counts and parameters for complications associated with PSE were measured during the follow-up. The mean values of leukocyte and thrombocyte, but not hemoglobin, were significantly increased after PSE (p < 0.01) in both groups. The values of leukocyte and thrombocyte during the long-term follow-up were significantly improved in BS group than that in gelfoam group (both p < 0.01). The frequency of bleeding episodes from esophageal varices in both groups was significantly reduced after PSE (both p < 0.01), but the post-PSE bleeding episodes showed no remarkable differences between the two groups (p = 0.084). Post-embolization syndrome consisted mainly of fever, nausea and vomiting, and abdominal pain in the two groups. The incidence of grade II to III abdominal pain in BS group (82.8%, 27/33) was significantly higher than in gelfoam group (57.9%, 33/57) (p = 0.020). The mean survival time was 61.5 ± 9.1 (median 60, 1–157) months in gelfoam group and 63.4 ± 9.9 (median 52, 0–161) months in BS group, which showed no significant difference (p = 0.930).In conclusion, BS particles could be used as the embolic material in PSE. Compared to gelfoam used in PSE, BS can achieve even better efficacy in alleviating hypersplenism. It provides a long-term effect on the hematological parameters, bleeding from esophageal varices and good palliation, and improved clinical status contributing to symptomatic control.

New techniques in the repair of anal sphincter between success and failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed A Darwish ◽  
Ahmed A Khalil ◽  
Mohammed A Hamed ◽  
ElnagehA AbdAlrahem
Keyword(s):  
Anal Sphincter ◽  
Sphincter Repair ◽  
P Value ◽  
University Hospitals ◽  
Endoanal Ultrasonography ◽  
Anal Sphincter Injury ◽  
Long Term Follow Up ◽  
The Mean

Abstract Background Fecal incontinence is a frequent and debilitating condition that may result from a multitude of different causes. It is defined as the uncontrolled passage of faeces or gas over at least 1 month’s duration, in an individual of at least 4 years of age, who had previously achieved control. Aim of Work to evaluate the outcome of overlap anal sphincter repair as regard the anal continence and postoperative complications. Patients and Methods this is a prospective clinical trial was conducted on thirty (30) patients presented to Ain-Shams University hospitals with anal sphincter injury that were operated upon by a modified overlap repair done by the same surgical team. Endoanal ultrasonography was done and Wexner continence score was estimated for all cases preoperatively and postoperatively. All patients sharing in the study were fully informed about the procedure they had with a written informed consent. Results In this study the mean preoperative Wexner score was 12.9 and the mean postoperative Wexner was 4.8; this reduction was found to be significant (p value=0.001). Also endoanal ultrasound showed that tear size significantly reduced among the studied cases(p value=0.001). Conclusion from this study that overlapping sphincter repair is an effective method in the treatment of faecal incontinence in patients with repairable sphincter defects. However, long term follow up is required to confirm its efficacy.

scholarly journals Evaluate the effectiveness of tonsillectomy and long-acting penicillin on the levels of the antistreptolysin O titer in children with recurrent tonsillitis

2019 ◽  
Vol 7 (5) ◽  
pp. 1692
Author(s):  
Alekh Kumar ◽  
Nupur Kumari
Keyword(s):  
Cost Effective ◽  
Chronic Tonsillitis ◽  
P Value ◽  
Bleeding Diathesis ◽  
Recurrent Tonsillitis ◽  
Long Term Follow Up ◽  
The Mean ◽  
Long Acting

Background: Tonsillitis is widespread among children and has serious poststreptococcal complications, and both the patients and clinician have to face the question on what is the role and benefit of using long-acting penicillin and whether it is an alternative method of treatment to surgery?. This study was carried out to evaluate the effectiveness of tonsillectomy compared with long-acting penicillin in the treatment of recurrent tonsillitis, comparing their effects on the levels of the antistreptolysin O titer (ASOT).Methods: A total of 100 patients aged 4-15 years with recurrent tonsillitis and signs of chronic tonsillitis, after exclusion of patients with bleeding diathesis, anemia, chronic illness, and criteria of rheumatic fever, were included in this study, they were divided to two groups comprising 50 patients each. The first group was treated by tonsillectomy, whereas the second group was treated using long-acting penicillin monthly for 6 months. They were clinically evaluated, ASOT levels were recorded for all patients before management and after 6 months.Results: The mean ASOT readings before management and after 6 months for the tonsillectomy group were 518.29 and 117.13 IU/ml, respectively (P value <0.004), whereas for the penicillin group, they were 526.70 and 262.98 IU/ml, respectively (P value <0.072).Conclusions: This study demonstrates that the first line of treatment of recurrent chronic tonsillitis is tonsillectomy, as it is both clinically effective and cost-effective for children and that the second line of treatment is long-acting penicillin with a long-term follow-up and in patients have contraindications for surgery such as bleeding diathesis.

scholarly journals A Prospective Randomized Comparative Study to Evaluate the Effect of Once Daily Dose of Tadalafil (5 mg) vs. On-Demand Tadalafil (10 mg) on International Index for Erectile Function (IIEF) Score

2020 ◽  
Vol 7 (46) ◽  
pp. 2694-2699
Author(s):  
N. Imdad Ali ◽  
Paresh Sankhe ◽  
Ravishankar T.H.S
Keyword(s):  
Erectile Dysfunction ◽  
Tertiary Care ◽  
Mean Difference ◽  
P Value ◽  
Once Daily ◽  
On Demand ◽  
Tertiary Care Medical Center ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

BACKGROUND Erectile dysfunction is a common condition affecting middle and old age men throughout the world. Tadalafil is preferred by many urologists as well as patients because of its long half-life. Tadalafil on demand was compared with daily dosing in many studies. We wanted to conduct the study in south India at a tertiary care medical center to study the effect of tadalafil daily (5 mg) vs. on demand (10 mg) and check its efficacy with the IIEF scoring system. METHODS Patients were randomised into two groups using simple randomization chit box method. Allocation concealments was done by sealed enveloped method. Before starting treatment IIEF scoring was done for both groups. Group A was given once-daily 5 mg tadalafil. The group B was given 10 mg tadalafil before sexual activity. All patients under either of the two medication regimens for a period of 12 wks. and assessment done at 4 wks. and 12 wks. interval. Both the patient and the examiner was blinded to the randomisation of the subjects. Scoring scale is 1 to 30 which is divided into five groups of sever, moderate, mild to moderate, mild, and no dysfunction for score of 0 - 10, 11 - 16, 17 - 21, 22 - 25, and 26 - 30 respectively. RESULTS Tadalafil 5 mg OD has statistically significant better result when compared with IIEF score after 4 wks. with percentage improvement of 21.12 % when compared to baseline, with a P value of < 0.0001. In group II tadalafil 10 mg on demand shows statistically significant results when IIEF score baseline was compared with that after 4 wks. When group I compared with group II for mean difference of score after 4 wks. group I shows statistically significant improvement with P value 0.017 (< 0.05). When compared with score after 16 wks. with baseline both group I and II shows statistically significant improvement in IIEF score. But group I which shows mean difference in score of 5.40 (42.05 % improvement from baseline) is a statistically significant difference (p value - 0.0001) when compared to group II which shows mean difference of score at 16 wks. as 2.73 (20.71 % improvement from baseline). CONCLUSIONS Tadalafil 5 mg daily provides significant increase in IIEF score as compared to on demand 10 mg tadalafil. We need longer duration of study the side effects in each group. KEYWORDS Tadalafil, IIEF, Once a Day, On Demand, Erectile Dysfunction

Validation of Positive Effect of Posaconazole Prophylaxis During Induction Chemotherapy in AML: Study of Invasive Aspergillosis Incidence and of Risk Factors On Short and Long-Term Survival.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4124-4124
Author(s):  
Mauricette Michallet ◽  
Mohamad Sobh ◽  
Stéphane Morisset ◽  
Giovanna Cannas ◽  
Franck Emmanuel Nicolini ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Induction Chemotherapy ◽  
Antifungal Prophylaxis ◽  
Control Group ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Control Group Group

Abstract Abstract 4124 We reported our experience on the antifungal prophylaxis by posaconazole in patients with acute myeloblastic leukaemia (AML) who were exposed to induction chemotherapy. To validate the benefit of an antifungal prophylaxis in this kind of population, we conducted a prospective study giving posaconazole (200mg per os x 3/24h) to all AML patients hospitalized for induction in the period 2007-2008 (group I) and to compare the observed results (incidence of severe invasive aspergillosis and overall survival) with a control group (group II) which was represented by all AML patients hospitalized for induction during the period 2006-2007 and who did not received any antifungal prophylaxis. There was in total 143 AML patients and after matching on age, gender, FAB classification and molecular markers, we got 121 patients (59 males and 62 females with a median age of 55 years): 55 patients in group I and 66 patients in group II. There were 91 AML de novo and 30 secondary AML, 18 patients had good cytogenetic markers, 43 intermediate and 58 poor (2 non evaluated). According to cytogenetics plus molecular markers, we distinguished 2 groups: a good prognostic group (n=29) associating favourable cytogenetics and intermediate 1 (normal cytogenetics+ Flt3 ITD, CEBPA,NMP1) and a poor prognosis group (n=75) with unfavourable cytogenetics and intermediate 2 (17 patients were not determined). As induction chemotherapy, patients received different combinations according to protocols, age and AML characteristics. The median interval between AML diagnosis and hospitalization was 0 day (-41 – +7), 92 patients (76%) were placed in laminar air flow rooms. After induction, 100 patients achieved a CR and 2 patients died during induction period. The median duration of aplasia and of hospitalization were 28 days (7 – 91) and 37 days (22 – 101) respectively. There was no significant difference for all the above characteristics between group I and group II. Concerning posaconazole prophylaxis, the treatment was started the 1st day of chemotherapy with a median duration of 27 days (8-94): 35 patients (64%) received their prophylaxis until their discharge, 7 (13%) discontinued due to toxicity [hepatic (n=3), renal (n=1), transfer to intensive care unit (n=3)] and 13 (23%) switched to another fungal treatment because of IA suspicion (n=5), probable IA (n=2) and invasive candidosis (n=5). Results At Day32 post induction, we observed 2 probable IA (3.6%) in group I and 8 IA [possible (n=4) + probable IA (n=4)] (12%) in group II (p = 0.085). The cumulative incidence of IA in group I and II was: at day 100, 7.27% vs 15.5%, at 1 year 12.72% vs 22.72% and at 18 months 14.54% vs 24.24% respectively. The Kaplan-Myer analysis on time to death from any cause at Day 100, showed a significant survival benefit in favour of the Pozaconazole group (group I) over the control group (group II) (p=0.0023) (figure1), this difference was also significant when we adjusted the analysis only on deaths caused by IA (figure2). After a median follow-up of 8.6 months, the probability of overall survival was 92.3% at day 100, 83.5% at 6 months, 70% at 1 year, 58% at 18 months and 36% at 2 years with a significant difference between groups I and II(p=0.02). At the last follow-up, 39 patients died in the group II and 10 in the group I. Concerning the other risk factors, the multivariate analysis showed a significant impact on long term OS of age [HR= 0.103 (0.02 – 0.5) (p= 0.00029) ], cytogenetics [HR=2.524 (1.172-5.44) (p=0.0018)] and response to induction [HR=7.73 (3.579-16.7) (p=1.9e-7)]. Conclusion We showed a very important impact of anti-fungal prophylaxis in patients undergoing chemotherapy for AML especially for invasive aspergillosis, which is a risk factor to take into account in addition to age, cytogenetics and response to treatment. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Evaluation of Salivary Procalcitonin and Macrophage Activating Factor in Generalised Chronic Periodontitis Patients with and without Type 2 Diabetes Mellitus

2021 ◽  
Author(s):  
Sindhu Ramarao Ghorpade ◽  
Vijayalakshmi Rajaram ◽  
Jaideep Mahendra ◽  
Burnice Nalinakumari Chelladurai ◽  
Ambalavanan Namasivayam
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Chronic Periodontitis ◽  
P Value ◽  
Group I ◽  
Significant Difference ◽  
The Mean ◽  
Group Ii

Introduction: Periodontitis is a polymicrobial and multifactorial oral disease and is the sixth complication of diabetes mellitus. Early diagnosis is important, and the use of non invasive biomarkers are highly useful for this purpose. The level of Macrophage Activating Factor (MAF) and Procalcitonin (ProCT) corresponds to the intensity of the inflammatory response and the severity of infection; thereby indicating that an increase in concentration or persistence of high values is considered as a prognostic indicator for severity of infection with an adverse outcome. Aim: To assess the periodontal parameters and quantify the levels of MAF and ProCT in saliva samples of generalised chronic periodontitis subjects with and without type 2 diabetes mellitus and to correlate these levels with the periodontal parameters. Materials and Methods: The study was a single centre cross- sectional study carried out at the Department of Periodontology, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India, from November 2018 to November 2019. A total of 80 subjects with generalised severe chronic periodontitis were selected and divided into two groups. Group I comprised of 40 subjects who were diagnosed with generalised chronic periodontitis without type 2 diabetes mellitus, whereas group II comprised of 40 subjects with generalised chronic periodontitis who had already been diagnosed with type 2 diabetes mellitus. Periodontal parameters such as Plaque Index (PI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) were recorded. The collected samples were subjected to molecular analysis for evaluating ProCT and MAF using Enzyme-Linked Immunosorbent assay (ELISA). Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 25.1 (Chicago, USA Inc). Student’s Independent t-test was used to compare the mean values for the variables in the control and test group. The Pearson’s correlation test was used to evaluate correlation between all the variables. The p-value <0.05 was set as the level of significance. Results: On comparing the periodontal parameters between group I and group II, there was no significant difference between the groups p-value >0.05. The mean salivary ProCT level in group I and group II was 268.76±152.78 ng/mL and 785.75±244.37 ng/mL, respectively. The mean salivary MAF level in group I and group II was 7.15±2.02 ng/mL and 26.56±9.12 ng/mL, respectively. On comparing MAF and ProCT value between group I and group II, there was a statistically significant increase in group II (p-value <0.001) and a weak correlation value with the periodontal parameters was seen. Conclusion: There was a significant difference in levels of MAF and ProCT in saliva samples of generalised chronic periodontitis subjects with and without type 2 diabetes mellitus, however the periodontal variables in each group did not correlate with MAF and ProCT.

scholarly journals Long-term follow-up and patient satisfaction after reduction mammoplasty: Superomedial versus inferior pedicle

2016 ◽  
Vol 49 (02) ◽  
pp. 214-219 ◽  
Author(s):  
Mohamed Makboul ◽  
Mahmoud S. Abdelhamid ◽  
Ghada S. Al-Attar
Keyword(s):  
Reduction Mammoplasty ◽  
Inferior Pedicle ◽  
Round Shape ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
The Mean ◽  
Breast Shape ◽  
Superomedial Pedicle

ABSTRACT Background: Surgery for hypertrophied breasts represents a challenge for plastic surgeons. The search for a good post-surgical cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, a round shape, good projection, small cicatrices that are not very perceptible, and a lasting result. Patients and Methods: This study was carried out on sixty cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and were asked for late post-operative results and overall patients’ satisfaction. Results: Long-term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistically significant difference. No statistically significant difference was observed between patients underwent either superomedial or inferior pedicle reduction mammoplasty with regard to breast shape symmetry, nipple symmetry and sensation. The mean score for satisfaction was higher among patients who underwent superomedial pedicle rather than the inferior pedicle method. Conclusion: The superomedial pedicle shows better long-term cosmetic results.

scholarly journals Fracture Resistance of Primary Canines Restorations Reinforced with a Flowable or a Packable Composite Resin Posts; In- Vitro

2021 ◽  
Author(s):  
Ghasem Ansari ◽  
Fatemeh javadi ◽  
Kiana Hanjani ◽  
Ahmad Najafi Abrandabadi ◽  
Mahshid Gashtasb ◽  
...  
Keyword(s):  
Fracture Resistance ◽  
Composite Resin ◽  
Testing Machine ◽  
P Value ◽  
Anterior Teeth ◽  
Group I ◽  
Significant Difference ◽  
The Mean ◽  
Group Ii ◽  
Type Of Fracture

Abstract Aim and Background: Restoration of severely damaged primary anterior teeth are deemed as serious challenges for pediatric dentists. The aim of this study was to evaluate the fracture resistance of primary canines restored with flowable or packable composite resin posts. Material and Methods This study was conducted on a group of extracted primary canines. After cutting the coronal section, standard pulpectomy was performed and root canals were filled with ZOE paste leaving 3 mm coronal root space. A liner was placed above the root canal filling as a barrier. Samples were then randomly divided into two groups of fifteen. Both groups, received etch, bond, then in group I Core Flo Composite resin placement into canal, in group II, post shaping using designated packable composite resin and inserted into the canal. Followed by Core buildup and Crown reconstruction using Z250 composite resin. Samples were mounted at 148 ° angle on the acrylic blocks and stored in de-ionized water for 72 hours. Fracture resistance was measured using Universal Testing Machine. Data analysis were performed using independent t-test. Chi- square test were also employed to assess the type of fracture within groups. Results The mean fracture resistance in the group I was 830.31(+/-328.69N) and 803.09(+/-326.45N) in group II. Moreover, statistical analyses of the results showed no significant difference between the mean values of the fracture resistance (p-value=0.822) of groups as well as the type of fracture (p-value=0.79) between groups. Conclusion The ease of use and proper adhesion of the Core Flo composite resin, seems to help its use in the reconstruction of severely destructed anterior primary teeth.

scholarly journals MO965THE EFFECT OF DEGREE OF HUMAN LEUCOCYTE ANTIGEN MISMATCH AMONG LIVE-DONOR KIDNEY TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Mostafa Alaskary ◽  
Yasser Hendy ◽  
Ahmed Donia ◽  
Hussein Sheashaa ◽  
Amira Emam
Keyword(s):  
Kidney Transplant ◽  
The Other ◽  
P Value ◽  
Kidney Transplant Recipients ◽  
Group Iii ◽  
Live Donor Kidney ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Abstract Background and Aims There is a strong evidence of importance of HLA matching in kidney transplantation and associations between HLA-DR mismatches and rejection, transplant glomerulopathy, graft failure, and death with functioning graft following kidney transplantation. Our aim is to evaluate the effect of degree of HLA mismatch on transplant outcome among live donor kidney transplant recepients. Method The current study is a retrospective cohort study which was performed in Urology and Nephrology Center, Mansoura University, Egypt. The study included 2200 kidney transplant recipients who underwent renal transplantation between March 1976 and August 2019. The patients were divided into 3 main groups according to the degree of HLA mismatch: Group I: 0, 1, 2 HLA mismatch (568 patients). Group II: 3 , 4 HLA mismatch (1462 patients). Group III: 5 HLA mismatch (170 patients Results Demographic and medical characteristics were comparable among the 3 groups. Transplantation from unrelated donors was more frequent among group III (p value: 0.001). Ischemia time was comparable and over 90% of the patients had immediate diuresis.The degree of HLA mismatch affected the choice of induction therapy as lymphocyte depleting agent (ATG) was used more frequently in group III while basliximab was used more frequently in group I (p value: 0.001). Patients in group I were maintained on dual immunosuppressive protocols more frequently than the other 2 groups where triple immunosuppressive protocols were commonly used (p value: 0.02).Tacrolimus-based protocol was used more among group I while cyclosporine-based regimen was frequently used among group III (p value: 0.002, 0.001 respectively). acute rejection episodes were more frequent with group II and III. (p value: 0.001). Chronic rejection was revealed in graft biopsies of group II and III more than group I (p value: 0.046). Incidence of post-transplant Hypertension and Diabetes mellitus was higher in group III (p value: 0.004, 0.016 respectively). Median serum creatinine after 1 year follow up didn't differ significantly between the studied groups. However, serum creatinine was higher in group III after 2, 3, 4 and 5 years post transplantation (p value: 0.006) with subsequent lower creatinine clearance (p value: 0.036). The majority of patients were alive with functioning graft at last follow-up especially in group I with statistically significant difference among the 3 groups (p value: 0.001). More patients were alive with failed graft at last follow up in group III than in the other 2 groups with statistically significant difference (p value: 0.003). There was comparable percent of patients among the 3 groups were died either with functioning or with failed graft. On the other hand the 5, 10 and 15 years graft and patient survival showed statistical significant difference among the 3 groups with better survival for group I (p value: 0.04, 0.001) Conclusion The degree of mismatch affected the choice of immunosuppressive regimen. Higher HLA mismatch was associated with higher incidence of diabetes and hypertension and lower patient and graft survival.

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