Objectives: The aim of this study was to evaluate the effectiveness of sitagliptin, alone or in combination with metformin, in kidney transplant patients with newly diagnosed new-onset diabetes mellitus after transplant who had inadequate glycemic control, compared with a group of patients receiving insulin glargine with special emphasis on weight gain. Materials and Methods: Newly diagnosed renal transplant patients with new-onset diabetes mellitus after a transplant was defined by a blood glucose ≥ 11.1 mmol/L after an oral glucose tolerance test were examined. They were treated with standard immunosuppression composed of triple therapy with tacrolimus or cyclosporine, mycophenolate mofetil or azathioprine, and prednisone. They had stable graft function for more than 6 months after the transplant. Results: Patients with new-onset diabetes mellitus after transplant (n=28) whose glycemia was not controlled adequately with oral hypoglycemic agents (either alone or in combination) received oral sitagliptin 100 mg once daily in addition to existing therapy for 12 weeks. Patients who received insulin glargine as add-on therapy (n=17) served as the control group. Data analyses included glycated hemoglobin, fasting plasma glucose, lipid profile, body weight, and the occurrence of hypoglycemia. We found significant reductions in glycated hemoglobin and fasting plasma glucose values after 12 weeks of additional sitagliptin therapy that were comparable to those with insulin glargine. While the addition of stagliptin resulted in a small weight loss (0.4 kg), the addition of insulin glargine resulted in a weight gain (0.8 kg). The overall incidence of adverse experiences was low and generally mild in both groups. Conclusions: In a group of renal transplant recipients with new-onset diabetes mellitus after a transplant in whom glycemia was not controlled adequately by oral hypoglycemic agents, the addition of sitagliptin helped to achieve glycemic control similar to insulin glargine but with a marginal weight advantage.

The performance of abbreviated Modification of Diet in Renal Disease formula (aMDRD) and the Cockroft-Gault adjusted for body surface (aCG) equations as compared with measured 125 I-iothalamate glomerular filtration rate was analyzed in patients with stable renal transplantation (RTx) and in potential living kidney donors (LKD). One hundred and thirty-one patients had RTx and 150 were LKD. The paired t-test showed that the estimated glomerular filtration rate (GFR) values through the aMDRD and the corrected CG equations were significantly different from each other (p < 0.01). There were significant differences between GFRs estimated using aCG and aMDRD equations (p < 0.001) in both groups (RTx and LKD) of different ages. The Pearson correlation coefficient between aCG and aMDRD equations was good (0.77, p < 0.01), but the kappa coefficient was 0.39, indicating a low agreement between the two formulae. In RTx patients with GFR <60 mL/min/1.73 m 2 , the aMDRD equation performed better than the aCG formula with respect to bias (-0.6 vs. 3.0 mL/min/ 1.73 m 2 , respectively) and accuracy within 30% (72% vs. 56%, respectively) and 50% (91% vs. 73%, respectively). Similar results are reported for 48 diabetic RTx patients. In the LKD, the aMDRD equation significantly underestimated the measured GFR when compared with the aCG formula, with a bias of -8.0 versus 2.2 mL/min/1.73 m 2 , respectively (p < 0.05). We can conclude that the Cockroft and MDRD equations cannot be used interchangeably in clinical transplantation practice and in order to adjust drug doses.

Objectives: Hepatitis C virus in renal transplant recipients is an independent risk factor for sickness and death. It has been shown that one might limit hepatitis C virus progression in liver transplant recipients with sirolimus-based immunosuppression. The mammalian target of rapamycin is an influential molecule for the anti-hepatitis C virus action of interferon. We report our experience with sirolimus conversion in hepatitis C virus-positive patients with chronic allograft nephropathy regarding hepatic and hematologic effects that might affect its future use. Materials and Methods: Twenty-five patients who had received renal transplants with anti-hepatitis C virus-positive and normal liver function were enrolled. Ten patients had allograft dysfunction because of cyclosporine nephrotoxicity. Sirolimus was initiated at 2 mg/d and adjusted to 6 to 8 ng/mL. Cyclosporine was gradually tapered and then stopped; 15 patients were used as a control group. Sirolimus-related hepatitis was defined as a rise in liver transferases or alkaline phosphatase or bilirubin over twice the upper limit of normal. Viral replication was defined as elevated liver enzymes and increasing viral load and/or biopsy-proven hepatitis C virus active hepatitis. Results: After conversion, there was a reduction of hemoglobin and hematocrit. In 1 patient, the immunosuppressive regimen was changed back to cyclosporine owing to anemia and hepatotoxicity leading to prompt return of hematocrit and liver enzymes to their original values. One of 10 antihepatitis C virus-positive patients (10.0%) developed sirolimus-associated hepatotoxicity, compared with 2 patients in the control group (13%). Sirolimus patients showed a significant decrease in the HCV PCR levels from 700 000 to 400 000 IU/mL; P < .001, compared to 680 000 to 660 000 IU/mL in cyclosporine patients; P = NS, with comparable levels of transaminases Conclusions: Our data suggest that sirolimus has the potential to suppress viral replication in hepatitis C virus-positive renal transplant candidates.

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The effect of schistosomiasis on quality of life [QOL] and productivity of workers was examined. In a textile factory in Alexandria, Egypt, personal, occupational and sociodemographic data were collected from 172 workers with schistosomiasis and 172 workers without schistosomiasis. Several indicators of productivity and the World Health Organization QOL brief were used to determine the impact of schistosomiasis. The disease affected the general, physical and independence, psychological and spiritual, and social domains of QOL. Although the productivity score of workers with schistosomiasis did not differ significantly from the control group, they had significantly lower additional hours of work and lower total incentives/month. A significant relationship was found between severity of schistosomiasis and QOL domains and productivity indicators.

Whether renal transplant recipients with anti-HCV antibodies positivity and normal liver function tests within the first year after transplantation have different morbidity and mortality and graft failure compared to anti-HCV-negative recipients remains controversial. In this retrospective study, on 411 renal transplant recipients, we analyzed grafts morbidity, survival, and liver function tests over a period of 8 years. Patients were stratified according to their anti-HCV antibody status 1 year after transplantation into anti-HCV-positive and HCV-negative patients. The presence of normal liver function tests was mandatory at inclusion. All patients received the same immunosuppressive protocol consisting of cyclosporine A, mycophenolate mofetil and steroids. One year after transplantation, 137 patients were anti-HCV negative (33 %) while the rest 274 (67 %) were positive. At 5 years of follow-up, the study population consisted of 205 patients (71 patients, 35 % with anti-HCV negativity, and 134, 65 % with positivity). At the end of the study, only 144 patients were followed up (43 patients, 30 % with negative anti-HCV and 101 patients, 70 %, with positivity). We found that graft survival was not different between both groups. Moreover, serum creatinine showed a trend to be lower in HCV-positive patients compared to negative group although difference was not statistically significant. The number of graft loss was not different between both groups. Moreover, there was no difference between both groups as regards prevalence of acute rejection, diabetes mellitus, hypertension, CMV disease and proteinuria. We can conclude that anti-HCV positivity for 8 years in patients with normal liver function tests at 1 year does not impact graft morbidity and patient survival.

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