فهرست مطالب

International Journal of Organ Transplantation Medicine
Volume:2 Issue: 4, Autumn 2011

  • تاریخ انتشار: 1390/11/26
  • تعداد عناوین: 8
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  • Ak Ali, J. Guo, H. Ahn, J. Shuster Page 149
    Background
    Corticosteroids are increasingly used in renal transplant patients to minimize organ rejection after transplantation. In attempts to reduce corticosteroids adverse effects, transplant professionals are customary attempted to taper off, and permanently stop corticosteroids after few months of administration with other immunosuppressants.
    Objective
    To evaluate clinical benefits and risks of late corticosteroid withdrawal in renal transplant patients treated with tacrolimus (TAC) or mycophenolate mofetil (MMF), or both.
    Methods
    A meta-analysis was performed of published randomized controlled trials that reported outcomes in kidney transplant patients who were randomized to corticosteroids maintenance or late withdrawal under concomitant immunosuppression by TAC, MMF or both. Outcomes included acute graft rejection; graft failure rate; all-cause mortality; incidence of post-transplant diabetes; change in serum creatinine and total cholesterol; and change in pediatric standardized height z-score. PubMed and Google Scholar were used in literature search between 1999 and April 1, 2010. Data were combined using unweighted random effects model.
    Results
    Nine studies randomized 1907 patients met the inclusion criteria: TAC (n=1); MMF (n=6); both (n=2). Compared to maintenance therapy, late corticosteroid withdrawal was associated with 34% increase in the risk of acute graft rejection (95% CI for OR: 0.47–3.82); 35% and 5% reductions in the risk of graft failure and patient’s all-cause mortality (95% CI for OR: 0.26–1.60; 0.23–3.93, respectively); and 4% increase in post-transplant diabetes risk (95% CI for OR: 0.45–2.41). Late corticosteroid withdrawal was associated with substantial reduction in total cholesterol levels (mean difference: 18.1 mg/dL; 95% CI: 7.1–29.0 mg/dL), but did not reduce serum creatinine levels (‑0.00 mg/dL; 95% CI: ‑0.17 to 0.17). Stopping corticosteroids was associated with better pediatric growth outcomes.
    Conclusion
    Late corticosteroid withdrawal under TAC and/or MMF-lead immunosuppression after kidney transplantation could provide benefits in terms of total cholesterol, patient and graft survival, and pediatric growth. This strategy, however did not reduce the risk of acute graft rejection, post-transplant diabetes mellitus, and deterioration in serum creatinine levels.
  • Rf Saidi, M. Hertl, Rt Chung, Dsc Ko, T. Kawai, J. Markmann, K. Bhan, Ab Cosimi, N. Elias Page 160
    Background
    Hepatitis C (HCV) is the most common indication for liver transplantation in the US.
    Objective
    Since steroids are the major stimulus of viral replication, we postulated that steroid-free immunosuppression might be a safer approach.
    Methods
    From January 1995 to October 2002, we used steroid plus calcineurin inhibitor (CNI) immunosuppression after liver transplantation for HCV (steroid group, n=81). From October 2002 to June 2007, rabbit antithymocyte globulin (RATG) induction, followed by CNI and azathioprine (RATG group, n=73) was utilized.
    Results
    There were no differences in 1- and 3-year patient/allograft survival rates. The incidence of acute rejection rate (19% vs. 28%), of biopsy-proven HCV recurrence (70% vs. 75%), and chronic rejection (6% vs. 9%) were comparable. The mean time to develop recurrent HCV was significantly longer in the RATG group (16.2 vs. 9.2 months, p=0.008). The incidence of severe portal fibrosis appears to be lower in RATG group compared to the steroid group; 14% vs. 4% (p=0.07).
    Conclusions
    RATG induction is safe and effective after liver transplantation for HCV, but has no impact on the incidence of HCV recurrence and patient/allograft survival. However, a significant delay in time to HCV recurrence and a trend toward less rejection and portal fibrosis was observed.
  • N. Simforoosh, S. Gooran, A. Tabibi, A. Bassiri, Mr Gharaati Page 167
    Background
    Renal transplantation is the procedure of choice for most of patients with end-stage renal disease. The graft, however can be procured from either cadaver or living donors.
    Objective
    To compare graft and patient survival among patients who underwent kidney transplantation from cadaver donor vs. living donor.
    Methods
    From April 2002 to February 2010, we performed 138 cadaver kidney transplantations. We reviewed and compared one-year graft and patient survival with 138 living kidney transplantations.
    Results
    One-year graft and patient survivals in cadaveric groups were 93% and 96%, respectively, and in living groups were 92% and 97%, respectively.
    Conclusion
    There was no significant difference in one-year graft and patient survival between living and cadaver donor kidney transplantation.
  • Mh Karimi, M. Motazedian, B. Geramizadeh, S. Nikeghbalian, R. Yaghobi, F. Abedi, M. Hossin Aghdaee, N. Azarpira, M. Arabpour, Z. Malekpour, M. Namayandeh Page 171
    Background
    Co-stimulatory molecules play a critical role in regulating T-cell function during CMV infection after liver transplantation.
    Objective
    To investigate the relationship between the polymorphisms of the co-stimulatory genes and the susceptibility to CMV infection after liver transplantation.
    Methods
    Single nucleotide polymorphisms (SNPs) in PD-1 gene (PD1.1 A/G, PD1.3 A/G, PD1.9 C/T) ICOS (-693 A/G, 1720 C/T), CTLA-4 gene (‑318 C/T, 1722 T/C, 1661 A/G, 49 A/G) and CD28 (+17 C/T) were analyzed by PCR-RFLP in 70 liver transplant patients. CMV infection was determined in these patients by antigenemia test.
    Results
    CTLA-4 49G showed significant association with CMV infection (p=0.03, OR=3.82, 95% CI: 0–3.5; p=0.01, OR=004, 95% CI: 0–1.3). G and T alleles in CTLA-4 gene (‑318 C/T and 1661 A/G) (p=0.03, OR=0, 95% CI: 0–3.5; p=0.01, OR=0.04, 95% CI: 0–1.3) were significantly higher in CMV-infected rejector group.
    Conclusion
    CTLA-4 have significant role in CMV pathogenesis and rejection among CMV-positive liver transplant patients.
  • Z. Parsaei Mehr, M. Hami, Z. Moshtagh Eshgh Page 178
    Background
    Anxiety and depression are the most common psychological disorders in kidney transplant recipients that may affect disease process and graft survival.
    Objective
    Based on the types of kidney donation in our country, living vs. cadaveric donation, we conducted this study to compare psychological problems in renal recipients.
    Methods
    This cross-sectional study was conducted on kidney transplant recipients who were categorized according to their donors to “living” and “cadaveric” groups. Patients with stable condition were followed monthly in outpatient clinics. The psychological status of each patient was assessed by clinical interview and Spielberg State Trait Anxiety Inventory and the Beck Depression Inventory (BDI). The calculated Cronbach alpha for the reliability of the total scale was 0.95.
    Results
    We recruited 120 recipients (60 patients in each group of living and cadaveric donor transplantation) for the study. There was no significant difference in demographic data between two studied groups (p>0.05). The mean±SD anxiety score was significantly lower among living transplant recipients compared to cadaveric transplant recipients (80.2±15.2 vs. 86.9±18.8 p=0.03). We also found significant relation between depression score and kind of graft donation (11.6±5.7 in living vs. 16.4±9.4 in cadaveric groups; p<0.005).
    Conclusion
    Psychological problems such as depression and anxiety are significantly higher in cadaveric than living renal recipients. Periodic psychological evaluations should be recommended for kidney transplant recipients, especially for the cadaveric group.
  • S. Sanavi, R. Afshar, N. Sanavi Page 184
    Background
    Tissue donation has been promising in prolonging the lives of people with life-threatening diseases.
    Objective
    To assess the attitude and willingness of high school students towards bone marrow (BM) and blood (as tissue) donation for maintaining a safe and adequate pool.
    Methods
    This cross-sectional study was conducted among the high school girls, aged 15–18 years, who studied in natural sciences, mathematics and humanities. All participants filled a questionnaire consisting of age, religion, education levels and study branch, attitude and willingness towards BM and blood donation according to a Likert scale.
    Results
    Out of 416 students, with the mean±SD age of 16.3±1.2 years, 31% studied in grade I, 27% in grade II (25% natural sciences, 27% mathematics, and 48% humanities), 26% in grade III (30% natural sciences, 34% mathematics, and 36% humanities), and 16% in pre-university level (college) (32% natural sciences, 42% mathematics, and 6% humanities). The students had highly positive attitudes toward BM and blood donation (mean±SD score of 4.2±0.54). The willingness for BM and blood donation was declared respectively, in 87% and 71% of respondents. Moreover, 16% of students wanted to donate only to their relatives and 84% to all persons in need of therapy. There was no significant correlation between the donation willingness and educational levels and study branch; however, these variables significantly correlated with attitude towards tissue donation (p=0.02, p=0.01, respectively).
    Conclusion
    Despite positive attitude towards BM and blood donation, willingness for BM donation is lesser than blood which may be attributed to insufficient information about this type of tissue donation. An organized educational program for high school students in all aspects of tissue donation seems necessary.
  • A. Al Marzouki, E. Tashkandi, Mu Farooq Page 188
    Background
    Several studies have suggested that knowledge, attitudes and determinants concerning organ donation are influenced by many factors including gender, educational level, occupation, sociodemographic status, income level, culture and religion.
    Objective
    To highlight the awareness of cardiopulmonary and brain death (CD and BD) among the physicians and their belief about the organ donation.
    Methods
    In a cross-sectional study, 15% of 1700 physicians working under the auspices of Ministry of Health in Makkah region, were selected randomly from two hospitals of Makkah city, i.e., Alnoor Specialist Hospital and King Abdalaziz Hospital. A self-administered questionnaire with dichotomous answers was distributed to them.
    Results
    Out of 185 respondents, 174 (94.1%) identified the right definition of BD and CD and 155 (83.3%) agreed organ donation. The difference among physicians to differentiate CD from BD was not significant (p=0.2).
    Conclusion
    Physicians had enough knowledge to differentiate CD from BD; most of them are highly positive regarding the concept of organ donation.
  • Mj Fatemi, M. Masoumi, E. Esfandiari Page 194
    Hand transplant program is a communion of physicians and researchers during the current decade. 72 hands and digits were transplanted in 53 patients over the past 13 years. Unlike a solid organ transplant, hand transplantation involves various tissues, so it is called “composite tissue allotransplantation.” This article discusses the plans for performing the first hand transplant in Iran.