Blood loss and surgical complication rates were higher in late failed graft nephrectomies. Surgical complications in intracapsular vs extracapsular nephrectomies were similar but blood loss and transfusions were higher for intracapsular nephrectomy. Acute rejection treatment, or prophylaxis with methylprednisolone or globulins increased the incidence of surgical complications.
Opportunistic Infections in transplant patients have a wide spectrum and may vary from asymptomatic to severe infections with high mortality. A better understanding of the epidemiology of endemic pathogens and clinical manifestations can contribute to the establishment of an early diagnosis as well as correct treatment aimed at decreasing morbidity and mortality.
In the majority of cases incisional hernia develops in the first 3 months after transplant surgery. The incidence is significantly higher in white patients and after cadaveric donor transplantation. Surgical complications of transplant surgery are important predisposing factors for incisional hernia after kidney transplantation. Surgical repair using polypropylene mesh is safe and effective in this group of patients.
Mycophenolate mofetil (MMF) is given to children in fixed doses based either on body weight or body surface area. There are data indicating mycophenolic acid (MPA) blood levels should be monitored in the early period of transplantation. However, there is little information regarding MPA pharmacokinetics (PK) in stable pediatric recipients. We evaluated MPA-PK in 20 stable renal transplant children (11.7±1.9 years) under long-term (46±31 months) MMF (26.1±7 mg/kg per day or 785±183 mg/m 2 per day) therapy plus prednisone and cyclosporin A (n=16), tacrolimus (n=3), or MMF/prednisone (n=1). Total MPA levels were measured using the EMIT-MPA assay at 0, 1, 2, 3, 4, 6, and 8 h after an oral dose of MMF. The level at 12 h was considered equal to the trough level for AUC 0-12 calculation. Mean C 0 , C max , AUC 0-12 , and T max were 3.46±1.32, 13.5±0.58 µg/ml, 63.2±24.4 µg.h/ml, and 1.3±0.6 h, respectively. Six (30%) children were considered to have an adequate exposure (36-54 µg.h/ml) to MPA, 11 (55%) showed an AUC 0-12 >54 µg.h/ml, and 3 (15%) showed an AUC 0-12 <36 µg.h/ml. A C max ≥10 µg/ml was seen in 13 (65%) children. MMF dose did not correlate with AUC 0-12 or C max . The combination of variables C 0 , C 1 , and C 4 provided an equation to predict exposure (r 2 =0.75) where AUC 0-12 =12.62+ (7.78xC 0 )+(0.90xC 1 )+(1.30xC 2 ) (P<0.001). The use of MMF without monitoring MPA blood levels may cause unnecessary overexposure to the drug in stable pediatric recipients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.