Kramer B.K.,University of Mannheim |
Kramer B.K.,University of Regensburg |
Klinger M.,Wroclaw Medical University |
Vitko S.,Institute for Clinical and Experimental Medicine |
And 21 more authors.
BACKGROUND: Long-term use of corticosteroids is associated with considerable morbidity, including cardiovascular and metabolic adverse effects. METHODS: This study evaluated the long-term efficacy and safety of two steroid-free regimens compared with a triple immunosuppressive therapy in renal transplant recipients. This was a 3-year follow-up to a 6-month, open-label, randomized, multicenter study. RESULTS: Data from 3 years were available for 421 (93.3%) of 451 patients in the original intent-to-treat population (143 tacrolimus/basiliximab [Tac/Bas], 139 tacrolimus/mycophenolate mofetil [Tac/MMF], and 139 tacrolimus/MMF/steroids [triple therapy]). In the time interval from 6 months to 3 years after transplantation, the incidence of biopsy-proven acute rejection was low and similar (Tac/Bas, 2.1%; Tac/MMF, 2.2%; triple therapy, 2.2%); Most rejection episodes occurred during the first 6 months of the study. Graft survival was high (Kaplan-Meier estimates: 92.7%, 92.5%, and 92.5%), as was patient survival (93.1%, 96.4%, and 97.0%). There were 10 graft losses (n=2, 4, and 4) and 12 patient deaths (n=5, 2, and 5). Renal function was well preserved throughout the study and similar between groups. There was a trend toward improved cardiovascular risk factors in the Tac/Bas group, including reduced total and low-density lipoprotein cholesterol and lower new-onset insulin use. There were no between-group differences in the incidence or type of adverse events. CONCLUSION: Higher rates of acute rejection early in treatment were seen with the steroid-free regimens, but this did not translate into poorer long-term outcomes, such as graft and patient survival and renal function. A trend for a more favorable cardiovascular risk profile was observed for steroid-free immunosuppression with Tac/Bas. Copyright © 2012 Lippincott Williams &Wilkins. Source
Rostaing L.,Toulouse University Hospital Center |
Charpentier B.,Bicetre Hospital |
Glyda M.,Province Hospital |
Rigotti P.,University of Padua |
And 5 more authors.
American Journal of Transplantation
Memory T cells play a central role in mediating allograft rejection and are a rational target for immunosuppressive therapy. Alefacept is a recombinant LFA3/IgG1 fusion protein that reduces the number of memory T cells in both psoriatic lesions and the peripheral circulation of psoriasis patients. This study evaluated the efficacy and safety of alefacept compared with placebo when combined with tacrolimus, mycophenolate mofetil and corticosteroids in de novo renal transplant recipients. Between December 2007 and March 2009 patients were randomized in a double-blind fashion to receive alefacept (n = 105) or placebo (n = 107) for 3 months and were then followed for a further 3 months. The primary efficacy endpoint was the incidence of biopsy-confirmed acute T cell mediated rejection (Banff grade ≥1) through Month 6. Memory T cell counts were significantly reduced in the alefacept group from Week 3 to study end compared with placebo. However, there was no significant difference between the alefacept and placebo groups for the primary efficacy endpoint (alefacept, 11.0% vs. placebo, 7.0%, p = 0.3). Patient and graft survival as well as renal function was similar between treatment groups. Safety and tolerability were generally similar between the treatment arms. Malignancy was higher in the alefacept treatment arm. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons. Source
Oszukowska L.,Province Hospital |
Oszukowska L.,Medical University of Lodz |
Knapska-Kucharska M.,Province Hospital |
Knapska-Kucharska M.,Medical University of Lodz |
And 4 more authors.
Introduction: The effects of selected drugs (see below) on the efficacy of (131I) radioiodine therapy were examined. Material and methods: The study involved 200 hyperthyroid patients, treated with radioactive iodine. They were divided into five groups (40 persons in each). In Group I - patients were administered 131I and thiamazole; in Group II they were given - 131I and lithium carbonate; in Group III they were given - 131I only (the assumed absorbed dose -150-200 Gy, the same as in Groups I and II, for which Group III was a control group); in Group IV they were given - 131I and prednisone; and in Group V they were given - 131I only (250-350 Gy, the same as in Group IV, for which Group V was a control group). Therapeutic results were analyzed after six months based on clinical and hormonal status. The evaluation also included effects of the initial hormonal status on the outcome of 131I therapy in Groups II and IV (v. respective controls, i.e. Groups III and V); such analysis was not performed in Group I because all the patients in that group were initially hyperthyroid. Results: In 145 patients (72.5%) the therapy with 131I was effective. In 55 patients (27.5%) the therapy was ineffective. The application of thiamazole during the peritherapeutic period in patients treated with 131I reduced the effectiveness of radioiodine, while lithium carbonate had no effect on the therapy outcome. Prednisone increased the effectiveness of the therapy with 131I. Normalisation of the initial concentration of TSH was advantageous for the 131I therapeutic outcome only when the assumed absorbed doses of 150-200 Gy were applied, while being of no avail for doses above 250 Gy. Conclusions: The present results indicate the necessity of careful analysis of administered drugs in hyperthyroid patients while qualifying them to 131I therapy. The initial concentration of TSH has no effect on the efficacy of radioiodine therapy in cases where absorbed doses are regarded to be ablative. Source
Gosciniak P.,Province Hospital |
Larysz B.,Province Hospital |
Baraniak J.,Province Hospital |
Jozwa R.,Province Hospital |
And 3 more authors.
We present a case of Gerbode type defect (left ventricular to right atrial communication) discovered in a 52 year-old man with atrial and ventricular septal defects. The patient was diagnosed using two-dimensional colour Doppler and transoesophageal echocardiography. We describe the echocardiographic features and review the anatomical consequences of such defects. Our aim was to remind readers about this rare organic heart disease that an inexperienced echocardiography specialist might easily mistake for a recoil wave of tricuspid valve incompetence and thus diagnose pulmonary hypertension. Copyright © Polskie Towarzystwo Kardiologiczne. Source
Kasznicki J.,Medical University of Lodz |
Kosmalski M.,Medical University of Lodz |
Makarewicz J.,Province Hospital |
Tarka J.,Province Hospital |
Drzewoski J.,Medical University of Lodz
Diabetologia Doswiadczalna i Kliniczna
We report the case of a Caucasian patient with insulin autoimmune syndrome (IAS), defined as the association of hypoglycemic episodes with insulin autoantibodies in individual not previously treated with exogenous insulin. In this patient hypoglycemic episodes preceded for many years the diagnosis of autoimmune diseases (megaloblastic anemia, Graves' disease) and multiple myeloma. This rare syndrome is extremely rare in Caucasians (30 cases described); however we suggest that the search for underlying autoimmune disease and/or neoplasm or monoclonal gammapathy should always be included into routine practice in patients with recurrent hypoglycemia of unknown cause. Copyright © 2011 Via Medica. Source