Prevention of acute graft rejection by the prostaglandin E1 analogue misoprostol in renal-transplant recipients treated with cyclosporine and prednisone

Article Abstract:

Prostaglandins are a group of biologically active fatty acids and those of the E and I series (the letters designate to aspects of their chemical structures) can act as immunosuppressants. Cyclosporine is a powerful immunosuppressant that improves the recovery of patients after organ transplantation, but it can be toxic. Drugs with structures similar to prostaglandin E1 can reduce the effects of renal ischemia (decreased blood supply to the kidney), a danger following kidney transplantation. It is possible that one reason for cyclosporine's toxicity is its inhibition of prostaglandins normally made by the kidney, and results from animal studies indicate that a prostaglandin E1 analogue (similar drug) can correct the renal abnormalities induced by cyclosporine. To determine the effect on kidney graft recipients of a prostaglandin E1 analogue, oral misoprostol was administered with cyclosporine to 38 patients. An additional 39 patients received cyclosporine and a placebo (inactive drug). All patients also received glucocorticoids and prednisone. Cyclosporine blood levels, renal function, and other drugs being taken, were monitored. Results showed that the blood level of creatinine, a compound associated with kidney function, was lower in the misoprostol group, an improvement that lasted throughout the study. These patients also had fewer graft rejection episodes (26 percent) than those in the placebo group (51 percent). Renal function improved with misoprostol whether or not graft rejection occurred. The rate of adverse events, such as diarrhea and infection, did not differ for the two groups. The reduced graft rejection and infection rate resulted in shorter rehospitalization periods for the misoprostol group. Overall, it appeared that this prostaglandin E1 analogue, when given with cyclosporine and prednisone, improved renal function in kidney transplant patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Graft rejection, Immunosuppressive agents, Immunosuppression, Misoprostol, Synthetic prostaglandins E

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Serum erythropoietin levels after renal transplantation

Article Abstract:

The blood level of erythropoietin, a hormone secreted by the kidneys which stimulates red blood cell production, was measured in 31 kidney-transplant patients being treated with cyclosporine, a drug which suppresses the disease-fighting immune system so that the transplanted kidney would not be rejected. Average levels of the hormone before surgery were similar to those in healthy subjects. A temporary increase just after surgery dropped to a level three times greater than normal, which lasted for an average of 280 days. The initial increase occurred before the transplanted kidney started to function, and was not accompained by an increase in red blood cell production. The second increase in erythropoietin levels occurred as the kidney started to function and as red blood cell output increased. After erythropoietin levels returned to normal, the volume of red blood cells continued to rise toward normal. In patients who have undergone a kidney transplant, small increases in levels of erythropoietin produced by the body cause an increase in red blood cell production to the same extent as large doses of erythropoietin administered to patients with an excess of urea, a compound formed by the liver, in the blood. Once started, red blood cell production in kidney-transplant patients can be sustained by normal levels of erythropoietin. The restoration of kidney function improves the response of red blood cell production to the hormone erythropoietin.

Analysis, Physiological aspects, Erythropoietin, Iron deficiency anemia, Hematocrit

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A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts

Article Abstract:

The oral administration of acyclovir has been shown to reduce the rate of cytomegalovirus infection in recipients of renal allografts. A test for the prevention of cytomegalovirus disease in recipients of kidney grafts from cadavers was conducted. The first dose of either acyclovir or placebo was taken by the patients six hours before transplantation. The rates of recovery from viruses of the blood and urine were significantly reduced in patients who had received acyclovir. Why acyclovir suppresses the replication of cyclmegalovirus was not determined.

Acyclovir, Cytomegaloviruses, Cytomegalovirus

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