Recent developments: Renal transplantation

Andrews, Peter

doi:10.1136/bmj.324.7336.530

Cited by 53 publications

(12 citation statements)

References 28 publications

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“…First, we were able to trace, 18 months post-transplantation, all transplanted subjects from a fairly large cohort of 339 patients who were not medically selected for health status at the time of initial assessment. In addition, many of our results are in line with the literature, not only in term of report of depressive symptoms [21-24], but also in terms of post-transplantation patient and graft survival [2,6,24,31-35], causes of death [2,31,32,34,36] and predictive factors of transplantation outcome [3-7]. Moreover, the major strength of this study is that the assessment of depressive symptoms took place not a few days before transplantation, but 6 months earlier on average.…”

Section: Discussionsupporting

confidence: 89%

Report of depressive symptoms on waiting list and mortality after liver and kidney transplantation: a prospective cohort study

et al. 2011

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BackgroundLittle research has explored pre-transplantation psychological factors as predictors of outcome after liver or kidney transplantation. Our objective is to determine whether report of depressive symptoms on waiting list predicts outcome of liver and kidney transplantation.MethodsPatients on waiting list for liver or kidney transplantation were classified for report or non-report of depressive symptoms on waiting list. 339 were transplanted 6 months later on average, and followed prospectively. The main outcome measures were graft failure and mortality 18 months post-transplantation.ResultsAmong the 339 patients, 51.6% reported depressive symptoms on waiting list, 16.5% had a graft failure and 7.4% died post-transplantation.Report of depressive symptoms on waiting list predicted a 3 to 4-fold decreased risk of graft failure and mortality 18-months post-transplantation, independently from age, gender, current cigarette smoking, anxiety symptoms, main primary diagnosis, UNOS score, number of comorbid diagnoses and history of transplantation. Data were consistent for liver and kidney transplantations. Other baseline predictive factors were: for graft failure, the main primary diagnosis and a shorter length since this diagnosis, and for mortality, older age, male gender and the main primary diagnosis.ConclusionFurther studies are needed to understand the underlying mechanisms of the association between report of depressive symptoms on waiting list and decreased risk of graft failure and mortality after transplantation.

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Section: Discussionsupporting

confidence: 89%

Report of depressive symptoms on waiting list and mortality after liver and kidney transplantation: a prospective cohort study

et al. 2011

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“…1 This significant improvement in short-term graft outcome was not followed by a similar advance in preventing graft loss caused by chronic graft injury. 2,3 The addition of mycophenolic acid (MPA) into contemporary immunosuppressive regimens represented an important step forward in the development of new therapeutic protocols in kidney transplantation.…”

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confidence: 92%

The Anti-Fibrotic Effect of Mycophenolic Acid–Induced Neutral Endopeptidase

Dell'Oglio

Zaza

Rossini

et al. 2010

Journal of the American Society of Nephrology

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Mycophenolic acid (MPA) appears to have anti-fibrotic effects, but the molecular mechanisms underlying this are unknown. We prospectively studied 35 stable kidney transplant recipients maintained on cyclosporine and azathioprine. We converted 20 patients from azathioprine to enteric-coated mycophenolate sodium (EC-MPS) and continued the remaining 15 patients on azathioprine. Exploratory mRNA expression profiling, performed on five randomly selected EC-MPS patients, revealed significant upregulation of neutral endopeptidase (NEP), which is an enzyme that degrades angiotensin II. We confirmed these microarray data by measuring levels of NEP expression in all subjects; in addition, we found that NEP gene expression correlated inversely with proteinuria. In an additional 33 patients, glomerular and tubular NEP protein levels from renal graft biopsies were significantly higher among the 13 patients receiving cyclosporine ϩ EC-MPS than among the 12 patients receiving cyclosporine ϩ azathioprine or 8 patients receiving cyclosporine alone. Glomerular NEP expression inversely correlated with glomerulosclerosis and proteinuria, and tubular NEP expression inversely correlated with interstitial fibrosis. Incubation of human proximal tubular cells with MPA increased NEP gene expression in a doseand time-dependent manner. Moreover, MPA reduced angiotensin II-induced expression of the profibrotic factor plasminogen activator inhibitor-1, and a specific NEP inhibitor completely reversed this effect. Taken together, our data suggest that MPA directly induces expression of neutral endopeptidase, which may reduce proteinuria and slow the progression of renal damage in kidney transplant recipients. 21: 215721: -216821: , 201021: . doi: 10.1681 Over the last decade, the continuous progress in the development of immunosuppressive agents has enhanced both the efficacy and safety of antirejection regimens after renal transplantation, leading to a dramatic reduction in the incidence of acute rejection. 1 This significant improvement in short-term graft outcome was not followed by a similar advance in preventing graft loss caused by chronic graft injury. 2,3 The addition of mycophenolic acid (MPA) into contemporary immunosuppressive regimens represented an important step forward in the development of new therapeutic protocols in kidney transplantation. J Am Soc NephrolMPA exerts its immunosuppressive effect by inhibiting the inosine 5Ј monophosphate dehydro-

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“…These symptoms are still indicators of potential oro-dental problems in children with renal failure, and upon detailed analysis, explain the changes occurring in the oral tissues of patients with renal disease. Survival rates of pediatric patients on dialysis treatment and transplantation have increased considerably in recent years, allowing the dental surgeon to follow these subjects over longer periods of time [7,8].…”

Section: Introductionmentioning

confidence: 99%

Oro-dental health in children with chronic renal failure and after renal transplantation: a clinical review

Lucas

Roberts

2005

Pediatr Nephrol

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As a consequence of chronic renal failure (CRF) and its treatment, a number of oro-dental changes occur that persist after the end-stage is reached. An early effect is enamel hypoplasia due to a defect of enamel development and mineralisation. This is usually reparable to a high aesthetic standard using dental composite filling material. Children with CRF have significantly less dental caries than healthy children due to the inhibitory effect of increased salivary urea levels. Grafted patients frequently develop gingival enlargement as a result of immunosuppression with cyclosporine A, which is further exacerbated by the additional use of antihypertensive calcium-blocking agents. Surgical reduction of gingival hyperplasia is effective and is required in approximately one third of adolescents. A very high standard of home care should be encouraged for all children with CRF in the form of thorough mechanical tooth cleaning and plaque inhibition through the use of an antibacterial mouthwash. In transplanted children presenting an increased risk of infection, antibiotic prophylaxis may be indicated for dental treatment procedures. The drug dosage should be adapted to the reduced renal function. Pediatric nephrologists should be aware that dental surgeons can make a considerable contribution to the general health and well-being of children with CRF. Thus, only oro-dental problems that are mainly encountered and treated by dental surgeons are reviewed.

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Recent developments: Renal transplantation

Cited by 53 publications

References 28 publications

Report of depressive symptoms on waiting list and mortality after liver and kidney transplantation: a prospective cohort study

Report of depressive symptoms on waiting list and mortality after liver and kidney transplantation: a prospective cohort study

The Anti-Fibrotic Effect of Mycophenolic Acid–Induced Neutral Endopeptidase

Oro-dental health in children with chronic renal failure and after renal transplantation: a clinical review

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