Hypertension after renal transplantation in patients treated with cyclosporin and azathioprine

Article Abstract:

High blood pressure (hypertension) frequently develops immediately after kidney transplants. If it persists, it can result in significant increases in cardiovascular and cerebrovascular complications and increased mortality and morbidity. This study was designed to identify the incidence and possible bases of posttransplantation hypertension and to compare the responses elicited from the drugs used in transplant to prevent organ rejection, cyclosporin and azathioprine. One hundred and two children who had undergone renal (kidney) transplants between 1973 and 1987 were selected for study. Cyclosporin was administered to 72 patients, but because of graft rejections, surgery and other complications associated with the transplant procedure, this group was finally reduced to 55 patients. For similar reasons, the group of those treated with azathioprine was reduced from 97 to 47 cases. Both groups were observed for five years. The incidence of hypertension following kidney transplantation is reported to be generally greater among children than adults. Antihypertensive therapy varied and included captopril, propranolol, hydralazine, nifedipine, alpha-methyldopa, and prednisolone. All of the cases in the study groups developed hypertension shortly after their transplants. After one year, 64 per cent of the cyclosporin group and 72 percent of the azathioprine group had persistent hypertension. Patients who had received transplants from living family donors had a greater incidence of hypertension than those who had received transplants from cadavers. Patients whose kidney disease had been present since birth had fewer instances of elevated blood pressure than those who had acquired their renal illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Cyclosporine, Cyclosporins, Azathioprine

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Peptic ulcer disease following renal transplantation in the cyclosporine era

Article Abstract:

A known complication of kidney transplantation is the development of peptic ulcer disease, which occurs in from 4 percent to 16 percent of transplant patients. Peptic ulcer disease is a serious complication of transplantation, causing high rates of illness and death. Patients who are taking steroids are known to be at risk. With the introduction of the immunosuppressive agent cyclosporine for transplant recipients, the doses of steroids have been reduced. A review was undertaken of 254 kidney or kidney-pancreas transplant patients to evaluate the effect of the current use of cyclosporine on the incidence of post-transplantation peptic ulcer disease. Patients underwent upper gastrointestinal examination prior to transplant surgery to identify the presence of peptic ulcer disease. Following transplant, anti-ulcer medication was given as a preventive measure. The data revealed that 26 patients (10 percent) developed peptic ulcer disease an average of 7.8 months after transplant surgery. Patients with no history of peptic ulcer disease prior to transplant and normal upper gastrointestinal examination had a 10 percent incidence of postoperative peptic ulcer disease; patients with positive prior history, but negative preoperative evaluation had a 15 percent incidence; patients with a positive history and positive preoperative evaluation had zero percent incidence of peptic ulcer disease. Four of the 26 patients died as a result of peptic ulcer complications (15 percent). These findings indicate that pretransplant screening is not reliable for predicting post-transplant peptic ulcer disease. Longer periods of prophylactic medical treatment after surgery are indicated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Peptic ulcer

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Polyvalent immune globulin and cytomegalovirus infection after renal transplantation

Article Abstract:

Infection is the most frequent cause of death in patients undergoing a kidney transplant, and cytomegalovirus is the most common cause of life-threatening infections in kidney transplant recipients. Studies have indicated that giving patients intravenous immunoglobulin (IgG), commercially prepared antibodies which can help fight disease, can offer some infection protection. One type of immunoglobulin, polyvalent IgG, was given to 28 patients after kidney transplantation. In one group that received 12 weekly infusions of IgG, moderately severe cytomegalovirus infections developed in eight out of 15 patients, compared with 10 of the 13 patients not receiving the treatment. Of the patients developing the infection, IgG did not appear to alter the severity of the infection. Life-threatening cytomegalovirus infections did not develop in either group. Therefore, the role of IgG therapy in preventing a fatal infection cannot be excluded. Polyvalent IgG infusion therapy after kidney transplantation did not prevent or improve cytomegalovirus infections. Of the patients in this study, fewer than 10 percent of the patients had no cytomegalovirus antibodies before treatment began, which may explain why no patients died from the infection. The prophylactic use of IgG in kidney transplant recipients is not recommended at this time.

Research, Immunoglobulins, Immunoglobulin G, Transplantation immunology, Cytomegaloviruses, Cytomegalovirus

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