Although basiliximab and rabbit anti-thymocyte globulin (ATG) are effective in delaying and reducing the incidence of acute rejection (AR) thus improving short-term graft survival, their impact on long-term graft survival has not been well established in renal transplant recipients. To evaluate the long-term efficacy after induction therapy with ATG/basiliximab in renal transplant recipients, we studied retrospectively 86 renal transplant recipients of living donor renal transplantation from 2003 to 2006; of them, 42 patients received induction with ATG three doses of 50 mg, 25 mg, 25 mg/day on 0, 1 and 2 post-operative days (POD) and 44 age-matched patients received induction with basiliximab (20 mg/day on 0 and 4 PODs). All the patients received tacrolimus, mycophenolate mofetil and corticosteroids as maintenance immunosuppressive therapy. Demographic characteristics were similar between both groups. Patient survival at 5 years was 90.5% in the ATG group and 84.1% in the basiliximab group, while graft survival was 83.4% and 77.3%, respectively. The incidence of acute rejection was 14.2% and 18.1% in the ATG and the basiliximab groups, respectively. The estimated mean glomerular filtration rates at 5 years post-transplantation was 52.1 mL/min and 49.1 mL/min and the mean serum creatinine levels were 1.55 ± 0.37 and 1.66 ± 0.51 mg/dL in the ATG and basiliximab groups, respectively. A low incidence of tuberculosis and cytomegalovirus (CMV) was observed in the ATG group. There were no significant differences between the two groups, and both induction regimens assured a safe and effective treatment and were associated with similar excellent long-term patient and graft survival.
Achievement of an immunosuppression-free condition defined as clinical operational tolerance is an ideal goal. We hereby report a case of clinical operational tolerance in a patient whose allograft is functioning normally, without immunosuppression, for more than 3 years. The patient withdrew from immunosuppression in 2011 following which his serum creatinine was 1.34 mg/dl and proteinuria was 178 mg/24 h. Flowcytometric studies showed an elevated number of B lymphocytes and NK cells. IL-10 cytokine levels had increased, whereas those of IFN-γ decreased, suggesting that both B lymphocytes and NK cells, with their immunoregulatory function, contribute to the maintenance of long-term graft function. Consequently, further studies in understanding the interactions of NK cells and B lymphocytes may give us a better insight into the underlying mechanisms that underpin organ tolerance.
The present study was intended to explore the phytochemical, antimicrobial and antioxidant potential of the E. milii stem. The stem of E. milii was extracted using solvents of various polarities such as hexane, chloroform, ethyl acetate, acetone, methanol, ethyl alcohol and water. Solvent extracts of E. milii stem were screened for phytochemicals, total phenol, flavonoid and tannin contents by using conventional protocols. Antimicrobial activity of bacteria and fungi was carried out by using agar well diffusion method. MIC, MBC and MFC were evaluated by broth dilution method. Antioxidant activity was investigated by DPPH (2,2-dyphenyl-1-picrylhydrazyl) assay. The results revealed that most of the phytochemicals tested were positive in crude stem extracts. Ethyl alcohol, methanol and aqueous extracts of E. milii stem were found to be more positive towards most of the phytochemicals such as steroids, terpenoids, saponins and flavonoids except free and combined reducing sugars. Methanol extract was found more potential and displayed very good antibacterial activity than the positive control (Streptomycin) and other solvent extracts. MIC values were observed to be in the range of 12.5 mg/ml to 75mg/ml and MBC values from 25 mg/ml to 100 mg/ml. Methanol and aqueous extracts of E. milii stem showed the highest antifungal activity against all the fungal strains tested than the positive control fluconazole with MIC values ranged between 6.25 to 25 mg/ml and MFC values from 12.5 to 50 mg/ml. Ethanol, methanol and aqueous extracts exhibited highest antioxidant activity and total phenol, flavonoid and tannin contents. The phytochemical, antimicrobial and antioxidant activity results suggesting that the stem of E. milii plant possesses potential bioactive compounds.
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