المؤلفون: Grossi, P. A., Righi, E., Gasperina, D. Dalla, Donati, D., Tozzi, M., Mangini, M., Astuti, N., Cuffari, S., Castelli, P., Carcano, G., Dionigi, G., Boggi, U., Costa, A. Nanni, Dionigi, R.

المصدر: American Journal of Transplantation; April 2012, Vol. 12 Issue: 4 p1039-1045, 7p

مستخلص: The advent of combined antiretroviral therapy (cART) dramatically changed the view of human immunodeficiency virus (HIV) infection as an exclusion criterion for solid organ transplantation, resulting in worldwide reports of successful transplants in HIV‐infected individuals. However, there are few reports on simultaneous pancreas–kidney transplant in HIV‐positive recipients detailing poor outcomes. A series of four pancreas–kidney transplant performed on HIV‐infected individuals between 2006 and 2009 is presented. All recipients reached stably undetectable HIV‐RNA after transplantation. All patients experienced early posttransplant infections (median day 30, range 9–128) with urinary tract infections and bacteremia being most commonly observed. In all cases, surgical complications led to laparotomic revisions (median day 18, range 1–44); two patients underwent cholecystectomy. One steroid‐responsive acute renal rejection (day 79) and one pancreatic graft failure (month 64) occurred. Frequent dose adjustments were required due to interference between cART and immunosuppressants. At a median follow‐up of 45 months (range, 26–67) we observed 100% patient survival with CD4 cell count >300 cells/mm3for all patients. Although limited by its small number, this case series represents the largest reported to date with encouraging long‐term outcomes in HIV‐positive pancreas–kidney transplant recipients.

المؤلفون: Grossi, P.A., Righi, E., Gasperina, D. Dalla, Donati, D., Tozzi, M., Mangini, M., Astuti, N., Cuffari, S., Castelli, P., Carcano, G., Dionigi, G., Boggi, U., Costa, A. Nanni, Dionigi, R.

المصدر: American journal of transplantation; April 2012, Vol. 12 Issue: 4 p1039-1045, 7p

مستخلص: The advent of combined antiretroviral therapy (cART) dramatically changed the view of human immunodeficiency virus (HIV) infection as an exclusion criterion for solid organ transplantation, resulting in worldwide reports of successful transplants in HIV-infected individuals. However, there are few reports on simultaneous pancreas–kidney transplant in HIV-positive recipients detailing poor outcomes. A series of four pancreas–kidney transplant performed on HIV-infected individuals between 2006 and 2009 is presented. All recipients reached stably undetectable HIV-RNA after transplantation. All patients experienced early posttransplant infections (median day 30, range 9–128) with urinary tract infections and bacteremia being most commonly observed. In all cases, surgical complications led to laparotomic revisions (median day 18, range 1–44); two patients underwent cholecystectomy. One steroid-responsive acute renal rejection (day 79) and one pancreatic graft failure (month 64) occurred. Frequent dose adjustments were required due to interference between cART and immunosuppressants. At a median follow-up of 45 months (range, 26–67) we observed 100% patient survival with CD4 cell count >300 cells/mm3for all patients. Although limited by its small number, this case series represents the largest reported to date with encouraging long-term outcomes in HIV-positive pancreas–kidney transplant recipients.

المؤلفون: Vitko, S., Wlodarczyk, Z., Kyllönen, L., Czajkowski, Z., Margreiter, R., Backman, L., Perner, F., Rigotti, P., Jaques, B., Abramowicz, D., Kessler, M., Sanchez-Plumed, J., Rostaing, L., Rodger, R.S., Donati, D., Vanrenterghem, Y.

المصدر: American journal of transplantation; March 2006, Vol. 6 Issue: 3 p531-538, 8p

مستخلص: Tacrolimus combined with mycophenolate mofetil (MMF) is an effective regimen in kidney transplantation. This study compared the efficacy of combining tacrolimus and two different dosages of sirolimus with an established tacrolimus-MMF regimen. Each day in addition to tacrolimus, 325 patients received 2 mg sirolimus (TAC-SRL2 mg), 325 patients received 0.5 mg sirolimus (TAC-SRL0.5 mg) and 327 patients 1 g MMF (TAC-MMF). The initial tacrolimus dose was 0.2 mg/kg/day. Sirolimus patients received loading doses of 6 or 1.5 mg, and daily doses of 2 or 0.5 mg thereafter. Steroid administration was identical for all groups. The incidence of biopsy-proven acute rejection was lower in the TAC-SRL2 mg group (15.7%) compared with the TAC-SRL0.5 mg (25.2%, p = 0.003) and the TAC-MMF groups (22.3%, p = 0.036). Six-month graft survival was 91.0% (TAC-SRL2 mg), 92.6% (TAC-SRL0.5 mg) and 92.4% (TAC-MMF); the respective values for patient survival were 98.1%, 97.8% and 97.9%. Thirty-four patients (10.5%), 19 patients (5.8%) and 16 patients (4.9%) in the TAC-SRL2 mg, TAC-SRL0.5 mg and TAC-MMF groups, respectively, discontinued the study because of adverse events. Hyperlipemia was reported more often in the TAC-SRL2 mg group (24.0%) compared with 19.4% (TAC-SRL0.5 mg) and 11.0% (TAC-MMF; p < 0.05). Combining 2 mg sirolimus/day with tacrolimus results in lower rates of acute rejection, but a higher incidence of adverse events.

المؤلفون: Vitko, S., Wlodarczyk, Z., Kyllönen, L., Czajkowski, Z., Margreiter, R., Backman, L., Perner, F., Rigotti, P., Jaques, B., Abramowicz, D., Kessler, M., Sanchez‐Plumed, J., Rostaing, L., Rodger, R.S., Donati, D., Vanrenterghem, Y.

المصدر: American Journal of Transplantation; March 2006, Vol. 6 Issue: 3 p531-538, 8p

مستخلص: Tacrolimus combined with mycophenolate mofetil (MMF) is an effective regimen in kidney transplantation. This study compared the efficacy of combining tacrolimus and two different dosages of sirolimus with an established tacrolimus‐MMF regimen. Each day in addition to tacrolimus, 325 patients received 2 mg sirolimus (TAC‐SRL2 mg), 325 patients received 0.5 mg sirolimus (TAC‐SRL0.5 mg) and 327 patients 1 g MMF (TAC‐MMF). The initial tacrolimus dose was 0.2 mg/kg/day. Sirolimus patients received loading doses of 6 or 1.5 mg, and daily doses of 2 or 0.5 mg thereafter. Steroid administration was identical for all groups. The incidence of biopsy‐proven acute rejection was lower in the TAC‐SRL2 mg group (15.7%) compared with the TAC‐SRL0.5 mg (25.2%, p = 0.003) and the TAC‐MMF groups (22.3%, p = 0.036). Six‐month graft survival was 91.0% (TAC‐SRL2 mg), 92.6% (TAC‐SRL0.5 mg) and 92.4% (TAC‐MMF); the respective values for patient survival were 98.1%, 97.8% and 97.9%. Thirty‐four patients (10.5%), 19 patients (5.8%) and 16 patients (4.9%) in the TAC‐SRL2 mg, TAC‐SRL0.5 mg and TAC‐MMF groups, respectively, discontinued the study because of adverse events. Hyperlipemia was reported more often in the TAC‐SRL2 mg group (24.0%) compared with 19.4% (TAC‐SRL0.5 mg) and 11.0% (TAC‐MMF; p < 0.05). Combining 2 mg sirolimus/day with tacrolimus results in lower rates of acute rejection, but a higher incidence of adverse events.