Selma Alagoz

A Comparison of Mycophenolate Mofetil With Mycophenolate Sodium in Renal Transplant Recipients on Tacrolimus-Based Treatment

We compared the tolerability and efficacy of mycophenolate mofetil (MMF) versus mycophenolate sodium (MPS) among renal transplant recipients on tacrolimus-based immunosuppression. The 105 patients who underwent kidney transplantation between January 2002 and March 2008 and were treated with steroid, tacrolimus, and a mycophenolic acid compound were enrolled in the study. From patient files we collected on demographics data, donors, immunosuppressive drug doses, biochemical and hematologic parameters, gastrointestinal and hematologic side effects, and kidney function. Fifty-six patients were prescribed MMF and 49 of them were taking MPS. Demographic parameters and pretransplantation dialysis duration were similar between the 2 groups. After the third month, the MPS dose was higher than that of MMF. There were no clinically important differences between the 2 groups, regarding other immunosuppressive drug doses. Gastrointestinal side effects were similar: 42.4% in the MMF versus 44.8% in the MPS group (P = .846). Six patients in the MMF group and 1 patient in the MPS group underwent a switch of the mycophenolic acid therapy due to severe gastrointestinal side effects (P = .183). Biopsy-proven acute rejection was reported in 6 patients on MMF and 7 patients on MPS therapy (P = .768). The log-rank test evaluating a 50% reduction in glomerular filtration rate (GFR) showed no significant difference between the 2 groups (P = .719). No deaths were recorded during the study period; there was only 1 graft loss, which occurred in the MMF group. We did not observe a significant difference in tolerability and efficacy between the 2 widely used mycophenolic acid derivatives. Economic considerations can be an important factor when choosing the drug.

Assessment of Anemia and Quality of Life in Patients With Renal Transplantation

PURPOSE Anemia is associated with poor quality of life in dialysis patients. However, data on this association are scarce on transplant patients. We aimed to find the frequency of anemia, and the effect of anemia on the quality-of-life parameters in patients who have undergone kidney transplantation. METHODS Anemia was defined by a hemoglobin (Hgb) level of <12 g/dL and severe anemia by a Hgb level of <10 g/dL. All patients were evaluated with the Kidney Disease Quality of Life (KDQOL-SF) scale forms. RESULTS Two hundred patients (128 male and 72 female; mean age, 39.2 ± 11.5 years) were examined. Anemia was found in 19% and severe anemia was found in 4.5% of all patients. Low glomerular filtration rate, young age, and female gender were demographic parameters associated with anemia. Parathormone levels were higher in the anemic group. The use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and mammalian target of rapamycin inhibitors was significantly higher in the anemic group. In addition, patients with anemia had a lower KDQOL-SF mental health component score than that of the patients without anemia. CONCLUSIONS Anemia was related to the degree of renal function in posttransplant patients. Anemia had an important influence on mental health in renal transplant patients.

Progression of coronary artery calcification in living kidney donors: a follow-up study.

Background: Data on the long-term mortality and morbidity of living kidney donors are scarce. In the general population, coronary artery calcification (CAC) and progression of CAC are predictors of future cardiac risk. We conducted a study to determine the progression of CAC in renal transplant donors. Methods: We used multidetector computed tomography to examine CAC in 75 former renal transplant donors. A baseline and a follow-up scan were performed and changes in CAC scores were evaluated in each subject individually to calculate the incidence of CAC progression. Results: Baseline CAC prevalence was 16% and the mean CAC score was 5.3 ± 25.8. At the follow-up scan that was performed after an average of 4.8 ± 0.3 years, CAC prevalence increased to 72% and the mean CAC score to 12.5 ± 23.4. Progression of the individual CAC score was found between 18.7 and 26.7%, depending on the method used to define progression. In patients with baseline CAC, the mean annualized rate of CAC progression was 2.1. Presence of hypertension, high systolic blood pressure and an increase in BMI were the determinants of CAC progression. Conclusions: The rate of CAC progression does not seem to be high in carefully selected donors.

Progression of Metabolic Syndrome in Renal Transplant Recipients

BACKGROUND Metabolic syndrome, which is closely related to insulin resistance, is highly prevalent in renal transplant recipients. PURPOSE We aimed to investigate prevalence, risk factors, and progression of metabolic syndrome in renal transplant recipients. METHODS One hundred fifty-eight renal transplant recipients who had been on transplantation for more than 1 year and 79 age-sex matched healthy controls were included in the cross-sectional phase of the study. We measured baseline characteristics, blood pressure, fasting blood glucose, and lipid profiles and we defined metabolic syndrome using the National Cholesterol Education Program Adult Treatment Panel III criteria. One hundred twenty-four renal transplant recipients were eligible for the second evaluation after 22.9 ± 3.8 months. Metabolic syndrome prevalence and homeostasis model assessment insulin resistance levels were evaluated during the follow-up period. RESULTS Overall, metabolic syndrome was present in 34.2% of the patients and 12.7% of the controls at the cross-sectional phase of the study (P = .000). Only the hypertension component of metabolic syndrome was significantly increased in patients compared to controls (P = .000). Pretransplantation weight and body mass index were significantly higher in patients who had metabolic syndrome (P = .000). During the follow-up period, prevalence of metabolic syndrome did not change (P = .510); however, body mass index and blood pressure increased and the high density lipoprotein cholesterol component of metabolic syndrome decreased (P = .001). We did not find any significant difference in glomerular filtration rate change among patients with and without metabolic syndrome (-2.2 ± 11.36 vs -6.14 ± 13.19; P = .091). Glucose metabolism parameters including hemoglobin A1c, insulin, and homeostasis model assessment insulin resistance were disturbed in patients with metabolic syndrome (P = .000, P = .001, P = .002, respectively). CONCLUSION Metabolic syndrome is highly prevalent in renal transplant recipients and closely associated with insulin resistance. The prominent criterion of metabolic syndrome in patients seems to be hypertension, especially high systolic blood pressure. The identification of metabolic syndrome as a risk factor may yield new treatment modalities to prevent it.

Single-frequency and multi-frequency bioimpedance analysis: What is the difference?

Bioelectrical impedance analysis is a promising method in determining the body compartments in haemodialysis patients. In this study, we aimed to investigate the agreement between two widely used methods: the single‐frequency and multi‐frequency bioelectrical impedance analyses.

The Frequency and Associated Factors for BK Virus Infection in a Center Performing Mainly Living Kidney Transplantations

Purpose: BK virus (BKV) nephropathy has increasingly become an important cause of morbidity in renal transplant recipients. We evaluated the frequency and associated factors for BKV infection in a center performing mainly living donor transplantations over a long time period. Methods: One hundred consecutive renal transplant patients were included. Quarterly visits were planned to examine urine for decoy cells and to measure the BKV DNA in the blood and urine. Renal biopsy was performed in case of deteriorated allograft function. Serological examinations for BKV immunoglobulin G (IgG) were performed in donors. Results: Throughout the entire follow-up period, the rates of viruria, viremia, and the positivity of decoy cells were 12%, 6%, and 13%, respectively. The negative and positive predictive values of decoy cells were 93.1% and 69.2%, respectively, for viruria, and 99.2% and 45.5%, respectively, for viremia. Biopsy-proven BKV nephropathy was observed in 1 patient. The BKV IgG was positive in all living donors. Viruria and viremia were associated with deceased donor transplantation, acute rejection, and pulse steroid therapy. In addition, viremia was associated with antithymocyte globulin therapy and a short duration of the posttransplant period. Conclusions: The frequency of BKV infection was lower in our transplant unit compared to previous reports. Reduced doses of immunosuppression seem to be the main factor that may explain the reduced frequency. However, an active screening strategy is still of importance for this patient group.

Long-Term Progression of Coronary Artery Calcification Is Independent of Classical Risk Factors, C-Reactive Protein, and Parathyroid Hormone in Renal Transplant Patients

Aims: Compared to the general population, mortality is significantly increased in renal transplant recipients. In the general population, coronary artery calcification (CAC) and its evolution over time are associated with cardiovascular and all-cause mortality, and the study of this biomarker could provide useful information for describing the long-term progression of coronary heart disease in renal transplant recipients. Methods: We followed up a cohort of 113 renal transplant patients by performing three multi-detector computed tomography studies over 83.6 ± 6.8 months. Data analysis was performed by logistic regression analysis and by mixed linear modelling. Results: Progression was observed in 34.5% of patients. Baseline CAC and time-to-transplantation were the sole variables that predicted CAC evolution over time. Neither classical nor nontraditional risk factors, biomarkers of renal function (GFR) and kidney damage (albuminuria) or biomarkers of bone mineral disorder (BMD), such as serum phosphorus, calcium, and PTH, were associated with the long-term progression of coronary calcification. Serum triglycerides predicted CAC progression only in logistic regression analysis, while in addition to baseline CAC, time to transplantation was the sole variable predicting CAC progression when the data were analyzed by mixed linear modelling. These data suggested that, in addition to the background calcification burden, other unmeasured factors play major roles in promoting the evolution of coronary calcification in the transplant population. Conclusion: CAC progression continued over the long-term follow-up of renal transplant patients. This phenomenon was unaccounted for by classical and nontraditional risk factors, as well as by biomarkers of renal dysfunction and renal damage.

Assessment of urinary epidermal growth factor level in patients with chronic kidney disease

Chronic kidney disease (CKD) is characterized by progressive loss of functioning nephrons and their replacement with fibrotic tissue over a period of months or years. The causes of CKD are mainly diabetes, hypertension and inflammatory kidney diseases. It is a life threatening disease; if not treated by dialysis or kidney transplant, CKD results in death. CKD has a long latent period in which the disease is clinically silent. Diagnosis and treatment is based mainly on clinical examination and biochemical markers assessing kidney function. Currently, glomerular filtration rate (GFR) and albuminuria are the ideal markers to assess kidney function. Unfortunately patients with CKD may have no symptom until the glomerular filtration rate (GFR) falls below 15ml/min.1 New biomarkers which are able to reflect kidney damage at an earlier stage is required to improve management and decrease the morbidity and mortality of the patients with CKD.

Gangliocytoma Presenting With Tacrolimus Neurotoxicity in a Renal Transplant Recipient: Case Report

Tacrolimus is a widely used macrolide immunosuppressant in transplant surgery, with mild and major neurologic side effects. A 21-year-old woman had undergone preemptive transplantation of a kidney from her mother. On the 1st postoperative day, the patient had headache, nausea, vomiting, and agitation. Magnetic resonance imaging (MRI) of the brain showed hyperintensity and a lesion in the right mesial temporal lobe. After we switched from tacrolimus to cyclosporine, the symptoms regressed. Persistence of the lesion, confirmed by repeated MRI, required that the patient be operated on. Pathologic examination showed the gangliocytoma, a rare brain tumor. Our case shows that preexisting brain lesions may cause tacrolimus-induced neurotoxicity in the early postoperative period.

A Solid Mass in the Chest Wall: An Unusual Presentation of Posttransplant Lymphoproliferative Disorder in a Renal Transplant Recipient.

Posttransplant lymphoproliferative disorder (PTLD) is one of the most common malignancies after kidney transplantation. Different clinical and histopathological forms of PTLD related to immunosuppression can be observed after organ transplantations. We report a 42-year-old woman who had undergone deceased donor renal transplantation with an unusual presentation of PTLD. The immunosuppressive treatment was discontinued and appropriate chemotherapy was started. However, the patient died despite this treatment. Different presentations of PTLD in transplant patients should also be kept in mind.