Is It Time to Use De Novo mTOR Inhibitors Posttransplant?
Abstract The use of mTOR inhibitors evokes debate in transplantation. Numerous clinical trials have explored the role of the mTOR inhibitors sirolimus and everolimus in kidney transplantation, but the results have been mixed; they have not shown a clear benefit over the current regimens. However, many of these trials were impacted by the difficulties and uncertainties in managing side effects and the dosing of the mTOR inhibitors. Being aware of the effective treatments available for these side effects, understanding the pathophysiology of the mTOR pathway allows patients to remain on therapy. Successful side effect management means that the longer term, advantageous benefits of mTOR inhibition can be gained by the kidney recipient and means that it is time to use de novo mTOR inhibitors in kidney recipients.
AbstractIschemia-reperfusion injury (IRI) is an inevitable consequence of kidney transplantation (KT). The aim of our study was to investigate the protective effect of a glycogen synthase kinase 3 β (GSK-3β) inhibitor against cold IRI in a rat renal transplantation (RT) model and a rat cold-IRI model through the toll-like receptor 4 (TLR4)/myeloid differentiation factor 88 (MyD88)/nuclear factor κ-light-chain-enhancer of the activated B cell (NF-κB) signaling pathway. We treated Sprague D awley (SD) rats in the RT and cold-IRI models with 5 mg/kg and 1 mg/kg, respectively, of the GSK-3β...
In the above-stated article, the bold data in Table 1 have been revised.
A 39-year-old male, live-related renal transplant recipient with stable graft function presented with multiple painless, non-itchy, papular lesions over the midback region. Three months later, these lesions became multiple abscesses with pus exudation (Figure 1). The patient had a history of injury to his midback from the sharp edge of cement stairs, which caused an abrasion. He had received a thymoglobulin induction and was on prednisolone, tacrolimus, and azathioprine. The microscopic examination of KOH mount of pus revealed multiple, septate, branch ing, brown-pigmented hyphae with thick-walled vesicular swellings...
Contrast-induced nephropathy (CIN) is a dreaded complication of peripheral vascular interventions (PVIs), especially for kidney transplant recipients (KTRs). However, the incidence of and factors associated with CIN in that population of patients have not been studied.
A 60-year-old African American male on immunosuppression for recent kidney transplant, who initially complained of multiple symptoms, including laryngitis, productive cough, nausea, vomiting, diarrhea, fatigue, and rib pain, was admitted and intubated secondary to critical hemorrhagic shock from frank alveolar hemorrhage on bronchoalveolar lavage. This was initially thought to be vasculitic in nature by primary team and consultants following a broad and unremarkable workup, including BAL cultures, stains, and cytology.
Authors: Heidary Rouchi A PMID: 31422396 [PubMed - in process]
CONCLUSION: Glucocorticoids is the the mainstay of treatment. Therenal function tests, of the vast majority of patients, normalizedwith treatment. Relapse may occur, so a follow-up over a longperiod of time is required. A high index of suspicion is neededfor diagnosis in asymptomatic patients. PMID: 31422391 [PubMed - in process]
CONCLUSION: Although we did not find a statistically significantrelationship between vitamin D levels and the CMV infection, CMVinfected patients had lower vitamin D level compared with noninfectedrecipients, hence vitamin D deficiency can be consideredas a risk factor for CMV reactivation after renal transplantation. PMID: 31422387 [PubMed - in process]
Authors: Saidi RF, Moghadasali R, Shekarchian S Abstract There has been ample of preclinical and animal studies whichshowed efficacy and safety of using mesenchymal stem cells (MSCs)after transplantation for tissue repair, immunosuppression ortolerance induction. However, there has been a significant progressrecently using MSCs in small clinical trials after transplantation. Recent results using MSCs after transplantation seem to befeasible and safe. However, there are some limitations to show theeffectiveness of these cells including source, dose, timing and routeof infusions. Currently, live donor kidney transpla...
Insights from the survival analyses recommend possible inclusion of functional status into Scientific Registry of Transplant Recipients'risk-adjusted models.