Abstract. Mycophenolate mofetil (MMF) significantly decreases acute rejection rates after renal transplantation, but intolerance often occurs, leading to dose reduction. The clinical effect of MMF dose reduction has not been clearly established. This study determined whether MMF dose reduction after renal transplantation was associated with subsequent risk of acute rejection. This retrospective cohort study assessed 213 renal transplant recipients. Cox regression was used to model MMF dose as a time-dependent variable, with time to first acute rejection as the primary outcome. One hundred twenty-six patients (59%) had a total of 176 MMF dose reductions during the study. MMF dose was reduced because of leukopenia (55.1%), gastrointestinal symptoms (22.2%), infection (7.4%), malignancy (1.1%), and unknown reasons (14.2%). The cumulative number of days with the MMF dose reduced below full dose was an independent predictor of acute rejection. The relative risk of rejection increased by 4% for every week that the MMF dose was reduced below full dose. No significant association was observed between the number of days with MMF dropped below full dose and allograft failure. The cumulative number of days with the MMF dose dropped below full dose is a significant predictor of acute rejection after renal transplantation. Clinicians need to be aware of the rejection risk when the MMF dose is reduced and maintain close surveillance on such patients.Mycophenolate mofetil (MMF) significantly decreases acute rejection rates after renal transplantation (1). However, hematologic abnormalities and gastrointestinal intolerance occur commonly when recommended doses of MMF are used (2-4). In phase III studies involving MMF, between 12.7% and 37.3% of treated patients experienced diarrhea (2-4). Similarly, leukopenia was significantly more common in the MMF group, occurring in 10.9% to 35% of patients (2,3). These side effects often require MMF dose reduction or even discontinuation. Squifflet et al. (5) reported that 53% of patients receiving MMF and tacrolimus required a MMF dose reduction because of side effects. Roth et al. (6) reported that 29.2% of patients discontinued MMF altogether because of leukopenia or gastrointestinal intolerance.The clinical effect of MMF dose reduction in renal transplantation has not been clearly established. Mourad et al. (7) reported that three patients developed acute rejection when their MMF dose was reduced for leukopenia. However, no statistical comparison was made to a control group (7). In a preliminary report, 50.3% of renal transplant recipients required a dose reduction of MMF because of side effects (8). The rate of acute rejection was significantly higher in those patients who had a MMF dose reduction compared with those who had no dose change (8). However, it is unclear from the abstract whether the rejection episodes occurred before or after the dose reduction and whether the dose reduction was properly analyzed by use of time-dependent methodology (8).The objective of this study was ...

Cultured epithelial autograft (CEA) has been used as an adjunct in burn wound coverage at the Vancouver Hospital and Health Sciences Centre since 1988, and has been available to all patients admitted with significant burn injuries. During the 5-year period from 1988 to 1992 inclusive, 28 patients treated with CEA survived long enough for assessment. The mean age was 35.3 years with a mean total body surface area burn of 52.2% and a mean total full thickness injury of 42.4%. CEA was applied to wounds covering between 2% and 35% body surface area (BSA; mean 10.4%) after excision to fat or fascia. Most wounds had interim homograft coverage. Preservation of homograft dermis was attempted in three patients at the time of removal without effect. The mean CEA "take" was 26.9% of the grafted area. Eight patients had 50% or greater take and were discharged with between 1 and 19% BSA covered with CEA. Thirteen patients had no take on wounds between 2 and 16% BSA. Overall mortality in burn patients treated at the Vancouver Hospital and Health Sciences Centre from 1988 to 1992 was not significantly different from 1983 to 1987 with the populations being similar in terms of total BSA burns, age, inhalation injury, and homograft availability. When compared to a matched control population from the preceding 5 years, when CEA was not available, there was no significant difference in duration of hospital stay or number of autograft harvests. However, approximately one more debridement without autograft harvest per CEA patient occurred. Timing and depth of wound excision, interim coverage, type of dressing, and wound microbiology were not found to influence good versus poor take. The anterior trunk and thighs were the best recipient sites. Subjective differences between CEA and meshed autograft were noted. The results show that after 5 years of use, CEA engraftment continues to be unpredictable and inconsistent, and hence, it should be used as only a biologic dressing and experimental adjunct to conventional burn wound coverage with split thickness autograft.

Full publication of abstracts presented at scientific meetings ranges from 25-74%. To determine the rate and factors associated with publication in organ transplantation, we examined abstracts presented at the American Transplant Congress in May 2000. Of 1147 abstracts, 607 (53%) achieved full publication at 4.5 years (mean 1.32 ± 0.88 years). Fifty-nine percent (357/607) were published in three transplantation journals. For randomized trials, the proportion published was 61%. On multivariate analysis, industry sponsorship (OR 1.78; 95% CI 1.04-3.06), basic science research (OR 1.68; 95% CI 1.32-2.14), non-American center (OR 1.67; 95% CI 1.28-2.20) and oral presentation (OR 1.36; 95% CI 1.07-1.73) were independent predictors of full publication. Nearly half of all abstracts presented at a transplantation meeting remain unpublished. This finding needs to be considered when interpreting systematic reviews in the field of transplantation.

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Implants containing metallic components have the potential to become heated or move within the patient while in the magnetic resonance (MR) environment. Despite containing a ferromagnetic core and having been in use for over 20 years, no information is available on the safety of veterinary radiofrequency identification devices during MR examinations. These devices are the most commonly encountered metallic implants in dogs and cats undergoing MR imaging. Three commercial veterinary microchips were evaluated for safety in the MR environment at 1 T. Parameters tested were translational force, torque, heating, artifact production, and function. Translation and torque were larger than that expected from normal activity under normal gravity. No significant heating was observed. Signal void artifacts may affect diagnosis if they are too close to the area of clinical importance. Microchip function was unaffected by routine clinical MR imaging. Capsule formation around devices is a major factor in counteracting translation and torque. Our findings support that is acceptable for patients to undergo MR imaging with this 1 T system following an interval of 3 months postimplantation to allow capsule growth. Because of the complex interactions involved, these observations may not be translatable to MR scanners of different field strength and/or manufacturer. Further safety testing of these and other radiofrequency identification devices is therefore recommended at different field strengths and equipment specifications.