Kidneys transplant recipients

It is often difficult to differentiate ARF from acute rejection in the kidney transplant recipient, as both conditions may present with similar symptoms and physical examination findings. However, fever and graft tenderness are more likely to occur with rejection while neurotoxicity is more likely to occur with cyclosporine or tacrolimus toxicity. Kidney biopsy is often needed to confirm the diagnosis of rejection.42... 

Muck, W., Mai, I., Fritsche, L., Ochmann, K., Rohde, G., Unger, S., Johne, A., Bauer, S., Budde, K., Roots, I., Neumayer, H.-H., Kuhlmann, J., Increase in cerivastatin systemic exposure after single and multiple dosing in cyclosporin-treated kidney transplant recipients, Clin. Pharmacol. Ther. 1999, 65, 251— 261. 

Novartis. (2010). Novartis receives US FDA approval for zortress (everolimus) to prevent organ rejection in adult kidney transplant recipients. Press release http //www.novartis.com. 

Webster AC, Lee VW, Chapman JR, Craig JC. Target of rapamycin inhibitors (sirolimus and everolimus) for primary immunosuppression of kidney transplant recipients a systematic review and meta-analysis of randomized trials. Transplantation 2006 81(9) 1234-48. 

Webster A, Woodroffe RC, Taylor RS, Chapman JR, Craig JC. Tacrolimus versus cyclosporin as primary immunosuppression for kidney transplant recipients. Cochrane Database Syst Rev 2005. 

In kidney transplant recipients, lumbar bone loss was significantly higher in 20 patients who took daily... 

Glucocorticoid-related complications have been described in 748 adult kidney transplant recipients, followed for at least 1 year. For bone/joint complications, the multivariate analysis showed that the only significant variable was the cumulative duration of glucocorticoid therapy. For avascular necrosis, no variables were significant (SEDA-19, 377 223). 

Cerivastatin 0.2 mg/day was well tolerated when given together with ciclosporin, although there were 3- to 5-fold increases in the plasma concentrations of cerivastatin and its metabolites when single-dose cerivastatin was given to 12 kidney transplant recipients taking ciclosporin 200 mg bd and to 12 healthy controls (9). Ciclosporin may have affected both the distribution of cerivastatin and its biotransformation in the liver. 

Muck W, Mai I, Fritsche L, Ochmann K, Rohde G, Unger S, Johne A, Bauer S, Budde K, Roots I, Neumayer HH, Kuhlmann J. Increase in cerivastatin systemic exposure after single and multiple dosing in cyclosporine-treated kidney transplant recipients. Clin Pharmacol Ther 1999 65(3) 251-61. 

Webster A, Pankhurst T, Rinaldi F, et al. Polyclonal and monoclonal antibodies for treating acute rejection episodes in kidney transplant recipients. Cochrane Database Syst Rev. 2006 CD004756. 

Besides glucose, other analytes of clinical value can be possibly quantified by noninvasive spectral analysis. In vivo concentrations of lactate and urea are examples. The concentration of lactate in blood is used clinically to follow intensive care treatments, to identify cardiac or liver failure, to determine hypoxia of tissues from atherosclerosis, and to detect bacterial infection. In vivo urea levels are valuable for optimizing hemodialysis treatments and tracking the accumulation of toxins for people with end-stage renal failure or recent kidney transplant recipients. 

M. Arnadottir, H. Thysell, and P. Nilsson-Ehle, Lipoprotein levels and post heparin lipase activities in kidney transplant recipients ciclosporin-versus nonciclosporin-treated patients, Am. J. Kidney Dis. 77 700-717 (1991). 

D3. Dantal, J., Bigot, E., Bogers, W., Testa, A., Kriaa, F., Jacques, Y., Hurault de Ligny, B., Niaudet, P., Charpentier, B., and Soulillou, J. P., Effect of plasma protein adsorption on protein excretion in kidney-transplant recipients with recurrent nephrotic syndrome. N. Engl. J. Med. 330, 7-14 (1994). 

Kuzuya T, Kobayashi T, Moriyama N, Nagasaka T, Yokoyama I, Uchida K, Nakao A, Nabeshima T. Amlodipine, but not MDR1 polymorphisms, alters the pharmacokinetics of cyclosporine A in Japanese kidney transplant recipients. Transplantation 2003 76 865-868. 

Turgeon DK, Normolle DP, Leichtman AB, et al. Erythromycin breath test predicts oral clearance of cyclosporine in kidney transplant recipients. Clin Pharmacol Ther 1992 52 471 178. 

Abramowicz D, Schandene L, Goldman M, et al. Release of tumor necrosis factor, interleukin-2, and gamma-interferon in serum after injection of OKT3 monoclonal antibody in kidney transplant recipients. Transplantation 1989 47 606. 

Cattani P, Capuano M, Graffeo R, Ricci R, Cerimele F, Cerimele D, Nanni G, Fadda G. Kaposi s sarcoma associated with previous human herpesvirus 8 infection in kidney transplant recipients. / Clin Microbiol 2001 39 506-8. 

Prevention of rejection episodes in kidney transplant recipients... 

Gender-related variability in drug response has also been suggested to be clinically important. For example, in treatment of HIV infections, mycophenolate metabolism is higher in male than female kidney transplant recipients. 

Samaniego M, Becker BN, Djamali A (2006). Drug insight Maintenance immunosuppression in kidney transplant recipients. Nat Clin Pr-act Nephrol 2 688-699. 

In two kidney transplant recipients taking sirolimus (FK506), plasma adenosine concentrations were significantly increased (47). The relevance of these results to the use of therapeutic intravenous adenosine in patients already taking sirolimus is not clear. 

Guieu R, Dussol B, Devaux C, Sampol J, Brunet P, Rochat H, Bechis G, Berland YF. Interactions between cyclosporine A and adenosine in kidney transplant recipients. Kidney Int 1998 53(l) 200-4. 

Winterberg B, Korte R, Lison AE. Clinical impact of aluminium load in kidney transplant recipients. Trace Elem Med 1991 8(Suppl l) 46-8. 

Ciclosporin increases the survival of allografts in man. However, it causes renal vasoconstriction and increases proximal tubular reabsorption, leading in some cases to hjrperten-sion (20). The concomitant use of calcium channel blockers can prevent most of these adverse effects of ciclosporin. However, some calcium channel blockers (verapamil, dUtia-zem, nicardipine) can increase plasma concentrations of ciclosporin up to three-fold through inhibition of cjhochrome P450. Eight different studies have been performed on the combination of amlodipine and ciclosporin given for 1-6 months to kidney transplant recipients, and the results have been reviewed (21). In three studies, in a total of 41 patients, amlodipine increased ciclosporin concentrations, while in the others, a total of 85 patients, there was no evidence of an interaction. 

Pol S, Cavalcanti R, Carnot F, Legendre C, Driss F, Chaix ML, Thervet E, Chkoff N, Brechot C, Berthelot P, Kreis H. Azathioprine hepatitis in kidney transplant recipients. A predisposing role of chronic viral hepatitis. Transplantation 1996 61(12) 1774-6. 

Nine kidney transplant recipients had an increase in trough whole blood ciclosporin concentrations of 24-341% after introduction of nicardipine (188). A similar interaction has been reported with diltiazem (189) and verapamil (190). 

Carmellini M, Frosini F, FUipponi F, Boggi U, Mosca F. Effect of cilastatin on cyclosporine-induced acute nephrotoxicity in kidney transplant recipients. Transplantation 1997 64(l) 164-6. 

Armenti VT, Ahlswede KM, Ahlswede BA, Cater JR, Jarrell BE, Mortiz MJ, Burke JF Jr. Variables affecting birthweight and graft survival in 197 pregnancies in cyclosporine-treated female kidney transplant recipients. Transplantation 1995 59(4) 476-9. 

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