You are here

Home » Content

RENAL TRANSPLANT HASTALARIND A PULSE METİLPREDNİZOLON TEDAVİSİ İLE İMMÜNSÜPRESYON İNDÜKSİYONU

BOLUS METHYLPREDNISOLONE AS INDUCTION THERAPY FOR IMMUNOSUPPRESSION IN RENAL TRANSPLANT RECIPIENTS

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2002

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Studies to prevent organ rejection in renal transplant patients are continuing. Improvement in HLA-matching and efficiency of immunosuppressive drugs are the most important factors. In this study, effects of single or three consecutive high dose (pulse) methylprednisolone therapy on acute rejection frequency in renal transplant recipients were investigated. Total of 30 patients were included in the study. There were 18 patients in the first group (10 M, 8 F, mean age 29.6±6.5) and single dose of 15 mg/kg methylprednisolone iv was given during the renal transplantation operation to these patients. The second group included 12 patients (8M, 4 F, mean age 31.2±7.9) and 15 mg/kg methylprednisolone iv was given during the renal transplantation operation and the same daily dose repeated next two days. Following high dose iv methylprednisolone treatment, prednisolone administration switched to oral route and dose reduced from 2.5-3 mg/kg to 20 mg/day in all patients in ten days. Other immunosuppressive drugs were cyclosporin-A (8 mg/kg bid) and 2.5-3 mg/kg azathioprine in all patients. Two groups were compared for delayed graft function, acute rejection episode, acute tubular necrosis and infection frequency which developed during the post transplant 6 months follow up period. There were no statistically important difference for delayed graft function, acute tubular necrosis and infection between two groups. However frequency of acute rejection attack was higher in the first group ( 44% versus 8%, p<0.05). Our results suggest that, use of three days high dose i.v. methyl prednisolone may be an alternative to decreases acute rejection frequency in renal transplant recipients.
Bookmark/Search this post with
Abstract (Original Language): 
Renal transplantasyon yapılan hastalarda organ rejeksiyonımu önlemeye yönelik çalışmalar devam etmektedir. Hem doku grubu uygunluğunun artırılması hem de immünsüpresyonun etkinliği rejeksiyon ataklarım önlemede en önemli faktörlerdir. Bu çalışmada, renal transplantasyon yapılan hastalarda tek doz ve üç gün ardışık yüksek doz metilprednizolon verilmesinin akut rejeksiyon sıklığına etkisi araştırıldı. Çalışmaya toplam 33 renal transplantasyon hastası dahil edildi. Birinci gruptaki 18 hastaya (10 E, 8 K, ortalama yaş 29.6±6.5) operasyon esnasında 15mg/kg metilprednizolon i.v. olarak verildi, daha sonraki günlerde ise prednizolon dozu oral olarak 2.5-3 mg/ gün başlanarak, günlük azaltmalarla 20 mg/güne kadar inildi. İkinci gruptaki 12 hastaya ise (8E, 4 K, ortalama yaş 31.2±7.9) operasyon esnasında 15mg/kg metilprednizolon i.v. olarak verildi, sonra iki gün daha aynı doz tekrar edildi ve üçüncü doz metilprednizolondan sonra steroid dozuna ilk gruba benzer şekilde devam edildi. Her iki grupta siklosporin-A (8 mg/kg oral) ve azathioprine (2.5-3 mg/kg oral) aynı şekilde kullanıldı. Heriki grup posttransplant ilk 6 aylık takiplerinde ortay çıkan, gecikmiş renal fonksiyon, akut rejeksiyon, akut tubuler nekroz ve infeksiyon bakımından karşılaştırıldı. İki grup arasında gecikmiş renal fonksiyon, akut tubuler nekroz ve infeksiyon sıklığı bakımından önemli bir farklılık yok iken akut rejeksiyon sıklığı birinci grupta anlamlı olarak daha fazlaydı (%44'e %8, p<0.05). Bu çalışmanın sonuçları, 3 günlük yüksek doz metilprednizolonun akut rejeksiyon sıklığını azaltabilen bir indüksiyon tedavisi olabileceğini göstermektedir.
FULL TEXT (PDF): 
PDF icon pdf_tndt_388.pdf
  • 2
116-120
  • Turkish

REFERENCES

References: 

1- Wuthrich RP, Weinreich T, Ambuhl PM, Schwarzkopf AK, Candinas D, Binswanger U. Reduced kidney transplant rejection rate and pharmacoeconomic advantage of mycophenolate mofetil. Nephrol Dial Transplant 1999;14(2):394-9.
2- McKee M, Segev D, Wise B, Case B, Neu A, Fivush B, Colombani P. Initial experience with FK506 (tacrolimus) in pediatric renal transplant recipients. J Pediatr Surg 1997;32(5):688-90.
3- Hall BM, Tiller DJ, Duggin GG, Horvath JS,
Farnsworth A, May J, Johnson JR, Sheil AG. Post-transplant acute renal failure in cadaver renal recipients treated with cyclosporine. Kidney Int, 1985, 28:2, 178¬86.
4- Novick AC, Hwei HH, Steinmuller D, Streem SB, Cunningham RJ, Steinhiiber D, Goormastic M, Buszta C. Detrimental effect of cyclosporine on initial function of cadaver renal allografts following extended preservation. Results of a randomized prospective
study. Transplantation, 1986, 42:2, 154-8.
5- Sommer BG, Henry M, Ferguson RM. Sequential antilymphoblast globulin and cyclosporine for renal transplantation. Transplantation, 1987, 43:1, 85-90
6- Tran HT, Acharya MK, McKay DB, Sayegh MH,
Carpenter CB, Auchincloss H JR, Kirkman RL, Milford EL. Avoidance of cyclosporine in renal transplantation: effects of daclizumab, mycophenolate mofetil, and steroids. J Am Soc Nephrol 2000; 11(10): 1903-9.
7- Lorber MI, Fastenau J, Wilson D, DiCesare J, Hall ML. A prospective economic evaluation of basiliximab (Simulect) therapy following renal transplantation. Clin
Transplant 2000;14(5):479-85.
8- Flechner SM, Goldfarb DA, Fairchild R, Modlin CS,
Fisher R, Mastroianni B, Boparai N, O'Malley KJ, Cook DJ, Novick AC. A randomized prospective trial of low-dose OKT3 induction therapy to prevent rejection and minimize side effects in recipients of kidney transplants. Transplantation 2000; 15:69
(11):2374-81.
9- Mussche MM, Ringoir SM, Lameire NN. High intravenous doses of methylprednisolone for acute cadaveric renal allograft rejection. Nephron, 1976;16:287-91.
10- Kimberly RP, Lockshin MD, Sherman RL, McDougal JS, Inman RD, Christian CL. High-dose intravenous methylprednisolone pulse therapy in systemic lupus
erythematosus. Am J Med, 1981,70:4, 817-24
11- Baethge BA, Lidsky MD, Goldberg JW. A study of
adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease. Ann Pharmacother, 1992;26:3, 316-20
12- Smith MD, Bertouch JV, Smith AM, Weatherall M,
Ahem MJ, Brooks PM, Roberts Thomson PJ. The clinical and immunological effects of pulse methylprednisolone therapy in rheumatoid arthritis. I.
Clinical effects. J Rheumatol, 1988; 15:2, 229-32
13- Prommool S, Jhangri GS, Cockfield SM, Halloran PF.
Time dependency of factors affecting renal allograft
survival. J Am Soc Nephrol 2000; 11(3):565-73
14- Moreso F, Seron D, Gil-Vernet S, Riera L, Fulladosa X, Ramos R, Alsina J, Grinyo JM. Donor age and delayed graft function as predictors of renal allograft survival in rejection-free patients. Nephrol Dial Transplant 1999;14:930-935.
15- F rei U, Brunkhorst R, Schindler R, Bode U, Repp H, Pichlmayr R, Koch KM. Present status of kidney
transplantation. Clin Nephrol 1992;38(supll I):s46-s52).
16- Opelz G. HLA Matching should be utilized for improving kidney transplant success rates. Transplantation Proceedings 1991;23:46-50.
17- Vathsala A, Woo KT. Renal transplantation in cyclosporine-treated recipients at the Singapore
General Hospital. Clin Transpl 1999;: 189-97
18- Hall BM, Tiller DJ, Duggin GG, Horvath JS,
Farnsworth A, May J, Johnson JR, Sheil AG. Post-transplant acute renal failure in cadaver renal recipients treated with cyclosporine. Kidney Int, 1985; 28:2, 178¬86.
19- Lennard TW; Parrott NR; Wilson RG; Proud G;
Farndon JR; Simpson JM; Taylor RM. Renal transplantation: the non-starters. Br J Surg, 1988; 75: 570-2
20- Szczech LA, Berlin JA, Feldman HI. The effect of antilymphocyte induction therapy on renal allograft survival. A meta-analysis of individual patient-level data. Anti-Lymphocyte Antibody Induction Therapy Study Group [see comments]. Ann Intern Med, 1998, 128:10,817-26
21- Grinyo JM, Gil Vernet S, Seron D, Hueso M, Fulladosa X, Cruzado JM, Moreso F, Fernandez A, Torras J, Riera L, Castelao AM, Alsina J. Primary immunosuppression with mycophenolate mofetil and antithymocyte globulin for kidney transplant recipients of a suboptimal graft. Nephrol Dial Transplant, 1998, 13:10,2601-4.
22- Yussim A, Shapira Z. Single-bolus high-dose ATG for prophylaxis of rejection in renal transplantation-a prospective, randomized study. Transpl Int 2000; 13
Suppl l:S293-4.
23- Hong JC, Kahan BD. Use of anti-CD25 monoclonal antibody in combination with rapamycin to eliminate cyclosporine treatment during the induction phase of immunosuppression. Transplantation, 1999, 68:5, 701¬4.
24- Tran HT, Acharya MK, McKay DB, Sayegh MH,
Carpenter CB, Auchincloss H JR, Kirkman RL, Milford EL. Avoidance of cyclosporine in renal transplantation: effects of daclizumab, mycophenolate mofetil, and
steroids. J Am Soc Nephrol 2000; 11(10): 1903-9.
25- Lorber MI, Fastenau J, Wilson D, DiCesare J, Hall ML.
A prospective economic evaluation of basiliximab (Simulect) therapy following renal transplantation. Clin Transplant 2000;14(5):479-85.
26- Cockfield SM, Preiksaitis J, Harvey E. İs sequential use of ALG and OKT3 in renal transplante associated with an increased incidence of fulminant posttransplant lymphoproliferative disorder? Transplant Proc 1991;23:1106
27- Oh CS, Stratte RJ, Fox BC, Sollinger HW, Belzer FO,
Maki DG. Increased infections associated with the use of OKT3 for treatment of steroid-resistant rejection in renal transplantation.Transplantation 1988;45:68-73.

Thank you for copying data from http://www.arastirmax.com