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By Erica Yama Nephrologist
Umasankar Mathuram Thiyagarajan, Amirthavarshini Ponnuswamy, Atul Bagul
Thymoglobulin (Thymoglobulin®; Genzyme, Cambridge, Mass., USA) is a polyclonal antibody which has been used in the field of transplantation over the last four decades. With an initial hesitancy, it is widely used now in the prevention and treatment of rejection following renal transplantation. Thymoglobulin's lack of nephrotoxic properties (unlike calcineurin inhibitors) may potentiate it to be a very useful induction therapy during the early days following transplantation, particularly in a donation after circulatory death programme...
2013: American Journal of Nephrology
Allyson Hart, Matthew R Weir, Bertram L Kasiske
Cardiovascular disease (CVD) remains the most common cause of death after kidney transplantation worldwide, with the highest event rate in the early postoperative period. In an attempt to address this issue, screening for CVD prior to transplant is common, but the clinical utility of screening asymptomatic transplant candidates remains unclear. A large degree of variation exists among both transplant center practice patterns and clinical practice guidelines regarding who should be screened, and opinions are based on mixed observational data with great potential for bias...
March 2015: Kidney International
Robert S Gaston, Vineeta Kumar, Arthur J Matas
The short- and long-term effects of unilateral nephrectomy on living donors have been important considerations for 60 years. Short-term risk is well established (0.03% mortality and <1% risk of major morbidity), but characterization of long-term risk is evolving. Relative to the general population, risk of mortality, ESRD, hypertension, proteinuria, and cardiovascular disease is comparable or lower. However, new studies comparing previous donors with equally healthy controls indicate increased risk of metabolic derangements (particularly involving calcium homeostasis), renal failure, and possibly, mortality...
May 2015: Journal of the American Society of Nephrology: JASN
Roslyn J Simms, Albert C M Ong
The increasing use of medical imaging as an investigative tool is leading to the incidental and frequent finding of renal cysts in the general population. The presence of a solitary or multiple renal cysts has been generally considered benign in the absence of a family history of renal cystic disease or evidence of chronic kidney disease. Nonetheless, a number of recent studies have questioned this consensus by reported associations with the development of hypertension or malignant change. For these reasons, some clinicians consider the presence of renal cysts to be a contraindication to kidney donation...
September 2014: Nephrology, Dialysis, Transplantation
Robert D Morgan, John M O'Callaghan, Simon R Knight, Peter J Morris
BACKGROUND: Alemtuzumab (MabCampath or Campath; Genzyme, Cambridge, MA) is a CD52-specific monoclonal antibody that causes profound and sustained lymphocyte depletion. Its use as an induction therapy in organ transplantation is increasing. Since our last systematic review in 2006, where we identified the need for good-quality randomized controlled trials (RCTs), several RCTs have been published that examine its efficacy and safety in kidney transplantation. The aim of this study was to evaluate the current evidence for alemtuzumab induction therapy in kidney transplantation...
June 27, 2012: Transplantation
Matthew P Welberry Smith, Aravind Cherukuri, Chas G Newstead, Andrew J P Lewington, Niaz Ahmad, Krish Menon, Stephen G Pollard, Padmini Prasad, Steve Tibble, Emma Giddings, Richard J Baker
BACKGROUND: The use of alemtuzumab as induction immunosuppression for renal transplantation introduces the possibility of long-term tacrolimus monotherapy, avoiding maintenance with both corticosteroids and mycophenolate mofetil (MMF). METHODS: We conducted a single-center, prospective, open-label, randomized controlled trial comparing two steroid avoidance regimens between December 2006 and November 2010. One hundred and sixteen adult patients were randomized to either basiliximab induction followed by tacrolimus and MMF maintenance or to alemtuzumab induction followed by tacrolimus monotherapy...
December 27, 2013: Transplantation
Daniel Abramowicz, Pierre Cochat, Frans H J Claas, Uwe Heemann, Julio Pascual, C Dudley, Paul Harden, Marivonne Hourmant, Umberto Maggiore, Maurizio Salvadori, Goce Spasovski, Jean-Paul Squifflet, J├╝rg Steiger, Armando Torres, Ondrej Viklicky, Martin Zeier, Raymond Vanholder, Wim Van Biesen, Evi Nagler
The European Best Practice Guideline group (EBPG) issued guidelines on the evaluation and selection of kidney donor and kidney transplant candidates, as well as post-transplant recipient care, in the year 2000 and 2002. The new European Renal Best Practice board decided in 2009 that these guidelines needed updating. In order to avoid duplication of efforts with kidney disease improving global outcomes, which published in 2009 clinical practice guidelines on the post-transplant care of kidney transplant recipients, we did not address these issues in the present guidelines...
November 2015: Nephrology, Dialysis, Transplantation
Leora M Birnbaum, Mark Lipman, Steven Paraskevas, Prosanto Chaudhury, Jean Tchervenkov, Dana Baran, Andrea Herrera-Gayol, Marcelo Cantarovich
Despite improving immunosuppressive protocols in renal transplantation, chronic allograft nephropathy (CAN) remains a major impediment to long-term graft survival. The optimal immunosuppressive regimen for a patient with CAN is unknown. The aim of this study is to evaluate the various immunosuppressive management strategies of biopsy-proven CAN and of chronic allograft dysfunction (CAD) (no biopsy). A systematic review of randomized trials (n = 12 trials with 635 patients) was conducted. Studies included patients who were >6 mo post-transplant...
April 2009: Clinical Journal of the American Society of Nephrology: CJASN
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