We analyzed the association between whole-blood trough tacrolimus (TAC) levels in the first days post-kidney transplant and acute cellular rejection (ACR) rates. Four hundred and sixty-four consecutive, deceased-donor kidney transplant recipients were included. All were treated with a combination of TAC, mycophenolate mofetil and prednisolone. Patients were analyzed in four groups based on quartiles of the mean TAC on days 2 and 5 post-transplant: Group 1: median TAC 11 ng/mL (n = 122, range 2-13.5 ng/mL), Group 2: median 17 ng/mL (n = 123, range 14-20 ng/mL), Group 3: median 24 ng/mL (n = 108, range 20.5-27 ng/mL) and Group 4: median 33.5 ng/mL (n = 116, range 27.5-77.5 ng/mL). A graded reduction in the rates of ACR was observed for each incremental days 2-5 TAC. The one-yr ACR rate was 24.03% (95% CI 17.26-32.88), 22.20% (95% CI 15.78-30.70), 13.41% (95% CI 8.15-21.63) and 8.69% (95% CI 4.77-15.55) for Groups 1-4, respectively (p = 0.003). This study suggests that higher early TACs are associated with reduced rates of ACR at one yr.
A study has been made to assess the incidence of hypertension in patients who have suffered an episode of renal trauma sufficiently severe to cause haematuria. Sixty-three patients were studied and 63 age- and sex-matched controls were also studied. At follow-up, 6–138 months after injury, 13 of the patients who had suffered renal trauma and 12 of the control subjects had a diastolic blood pressure above 90 mm Hg. Three patients showed significant reduction in the size and volume of the previously damaged kidney. In this group, renal trauma did not appear to be associated with an increased risk of permanent hypertension.
SummaryA patient is described who developed the lesion of Kaposi's sarcoma 4 months after receiving a cadaveric renal transplant. Immunosuppression had been achieved using cyclosporin A and prednisolone. The lesions spread from the hands to other areas, but later regressed when the dose of cyclosporin A was reduced to 100 mg daily. The patient remains well with no evidence of rejection 15 months later.
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