Biomedical subjects

M Haberal

Publications and source records attributed to M Haberal.

At least 73 records · Page 4Linked to original sources

PubMed2005

Effect of routine insertion of a double-J stent after living related renal transplantation.

It is still not clear whether double-J stents (DJS) are of benefit. We sought to determine whether routine prophylactic use of DJS reduced postoperative complications after renal transplantation. We prospectively evaluated 42 living donor renal transplantations performed between September 2001 and September 2003. The patients were randomly assigned to one of two groups: 21 operations (group 1), included a DJS placed during Lich-Gregoir ureterocystotomy and 21 cases (group 2), a Lich-Gregoir ureterostomy without DJS insertion. Among group 1, the DJS were removed within the first month after transplantation. One patient in group 1 (5%) developed a urinary leakage. In group 2, there was one case of delayed graft function (5%) and one patient developed a hematoma (5%) at the operative site. The group rates for urinary tract infection were not significantly different (P > .05). In the early postoperative period, a renal biopsy was performed if a patient's creatinine level was elevated or remained elevated during 3 days after transplantation. Four patients in group 1 and 10 patients in group 2 required a renal biopsy (P = .04). All four of the group 1 biopsies and three of the group 2 specimens revealed acute rejection. The other seven group 2 biopsies showed tubuloepithelial injury. We suggest that ureteral stasis may cause tubuloepithelial injury and slow down the decrease in creatinine levels. In our model, the DJS did not increase urinary tract infections but provided a smooth decline in creatinine levels, which may reduce the question of acute rejection.

Follow-Up Studies↗

PubMed2005

The effect of anesthetic technique on early postoperative renal function after donor nephrectomy: a preliminary report.

General and regional anesthesia may both be used successfully in donor nephrectomy although the use of regional anesthesia is rare. We compared the remaining kidney function during general (n = 10) versus combined spinal-epidural (n = 10) anesthesia for donor surgery. Blood biochemistry data were collected preoperatively and postoperatively, while renal function was assessed by scintigraphy and urine levels of microalbumin, creatinine, Na, K, Ca and creatinine clearance rate were measured/calculated in 24-hour urine samples collected preoperatively and on postoperative day 2. There were no differences preoperatively and on postoperative day 2 with respect to glomerular filtration rate, microalbuminuria, or creatinine clearance rate (P > .05 for all). There were also no differences between the groups with respect to other scintigraphic findings preoperatively and on postoperative day 2 (P > .05 for all). The results suggest that general or combined spinal-epidural anesthesia for donor nephrectomy have similar effects on the remaining donor kidney function.

Anesthesia, Epidural↗

PubMed2005

Liver transplantation and tacrolimus monotherapy for hepatocellular carcinoma with expanded criteria.

Liver transplantation is the only curative treatment option for patients with cirrhosis and unresectable hepatocellular carcinoma (HCC) without extrahepatic dissemination. Criteria for transplantation in HCC are controversial. In this study, we evaluate the early results of liver transplantation for unresectable HCC. Between 2003 and 2004, 10 patients (three woman, seven men; aged 1.1 to 64 years) with occult or incidental HCC underwent liver transplantation. The inclusion criteria (independent of tumor size and number of tumor nodules) were: no invasion of major vascular structures and no evidence of extrahepatic disease, including that based on hilar lymph node biopsy and cytopathological examination of intraperitoneal fluid. Eight patients (80%) received tacrolimus and two patients (20%) received rapamycin monotherapy with early withdrawal of the corticosteroid. Four patients had neoadjuvant chemoembolization before transplantation. None of the patients received adjuvant chemotherapy. Two patients with hepatitis B virus cirrhosis underwent antiviral prophylaxis with anti-HBs antibody and lamivudine. During follow-up (range, 8 to 19 months), all patients did well with excellent graft function. There was no evidence of tumor recurrence on imaging studies, and there were no elevations in alpha fetoprotein or carcinoembryonic antigen levels. Low-dose immunosuppression and expanded criteria for liver transplantation for HCC appear to have beneficial effects on disease recurrence and patient outcomes, especially in regard to living donation.

Adolescent↗

PubMed2005

Living-related liver transplantation in pediatric patients.

INTRODUCTION: Many developments in surgical technique, immunosuppression, and patient selection criteria have led to improved long-term patient and graft survival in pediatric patients receiving liver transplants. In this study, we examined the early results of 26 pediatric recipients who underwent 26 liver transplantations between January 2003 and December 2004 at our institution. MATERIALS AND METHODS: The most common indications for liver transplantation were cholestasis in 10 patients (38.5%) and Wilson's disease in 8 (30.8%). Other indications were fulminant hepatic failure (4 patients, 15.4%), tyrosinemia (2 patients, 7.7%), Caroli disease (1 patient, 3.8%), and cryptogenic cirrhosis (1 patient, 3.8%). One recipient with Byler disease and two with tyrosinemia also had incidental hepatocellular carcinoma. RESULTS: Of 26 patients, 24 (92.3%) underwent living-related liver transplantation and 2 (7.7%) underwent cadaveric transplantation. The medical records of all patients were retrospectively reviewed. Twenty-two of 26 survived with excellent graft function, showing 91.2%, 86.4%, and 81.6% at 3, 12, and 24 months graft and patient survival rates, respectively. Sixteen patients (61.5%) developed various morbidities with biliary and vascular complications being the most common. Four patients (15.3%) developed bile leaks. Four patients (15.3%) developed hepatic artery thromboses. Five patients (19.2%) developed life-threatening infections. Four patients (15.4%) died during the study period, three owing to infectious complications. The other patient died due to acute respiratory distress syndrome. CONCLUSION: Despite technical difficulties and a donor organ shortage, the results of liver transplantation in pediatric patients with end-stage liver disease have demonstrated promising results at our institution.

Adolescent↗

PubMed2005

Influence of HLA compatibility on success with living-related pediatric liver transplantation.

It is not clear how HLA compatibility influences acute rejection and postoperative complications in cadaveric liver transplantation. Even less is known about this factor in pediatric living-related liver transplantation (LRLT). This research assessed HLA compatibility relative to rejection rates and complications in pediatric LRLT. The study retrospectively investigated data from 14 pediatric LRLTs in which the donor and recipient HLA genotypes were determined preoperatively. Three recipients (21.4%) developed biliary complications (two biliary leakage, one bile duct stenosis). Three others (21.4%) developed vascular complications (two hepatic artery thrombosis, one hepatic artery stenosis). Eight recipients (57.1%) were diagnosed with acute rejection. The incidence of acute rejection was not correlated with the number of HLA mismatches (P > .05), or with the number of HLA class I mismatches (P > .05); however, it was negatively correlated with number of HLA class II mismatches (P = .02). Arterial and biliary complications were not correlated with any of these categories of HLA compatibility. In conclusion, the data from this small group of patients provided no evidence that closeness of donor-recipient HLA matching influences outcome in pediatric LRLT.

Adolescent↗

PubMed2005

Effect of amyloidosis on long-term survival in kidney transplantation.

Amyloidosis is characterized by the accumulation of an amorphous material in various organs and tissues secondary to a variety of inflammatory, immune, infectious, and hereditary diseases. Since 1975, our transplantation team has performed 1470 renal transplantations. Between 1985 and July 2004, among 1159 kidney transplantations, 953 (82.3%) were from living donors and 206 (17.7%) from cadaveric donors. There were 32 recipients (28 men, 4 women; mean age, 31.4 +/- 1.7 years; range, 21 to 48 years) with amyloidosis, including, 28 (87.5%) who received grafts from living donors and 4 (12.5%) from cadaveric donors. Amyloidosis was secondary to familial Mediterranean fever in 22 (68.7%) patients and rheumatoid arthritis in 1 (3.1%). The remaining 9 (28.1%) patients had primary amyloidosis. The mean follow-up time was 51.2 +/- 5.7 months (range, 2-124 months). Mean HLA mismatch rate was 2.2 +/- 1. Twenty-six (81.2%) patients are alive at this time with functioning grafts, and a mean serum creatinine value of 2.1 +/- 1.5 ng/dL. The 1- and 5-year patient and graft survival rates were 90.6% and 84.3%, and 81.2% and 68.7%, respectively. We conclude that patients with amyloidosis may undergo kidney transplantation safely expecting outcomes similar to those patients who receive transplantations for other reasons.

Adult↗

PubMed2005

Effects of smoking and blood eosinophil count on the development of arteriovenous fistulae thrombosis in hemodialysis patients.

Arteriovenous fistulae (AVF) failure is the most common cause of morbidity and hospitalization in hemodialysis (HD) patients. The purpose of this study was to determine the effects of smoking and blood eosinophil count on the development of AVF thrombosis in HD patients. This cross-sectional study included 141 patients (M/F 80/61; age 43.4 +/- 11.6 years, HD duration 7.7 +/- 4.4 years). The following were analyzed as possible risk factors for AVF failure for all patients: demographic features, dialysis time, smoking, medications, body mass index, comorbid diseases, and various laboratory parameters (whole blood count and serum levels of albumin, calcium, phosphorus, uric acid, C-reactive protein, ferritin, and parathyroid hormone). AVF thrombosis was detected in 60 patients; in contrast, 81 patients had no thrombosis. Distributions of age, gender, and HD duration were similar between both groups. Univariate analysis showed that snuffbox AVF location (P < .0001), higher blood eosinophil count (P < .0001), smoking (P < .01), and higher hematocrit level (P < .05) were all associated with AVF thrombosis. According to multivariate analysis by logistic regression models, eosinophil count (RR = 1.005, P < .05) and snuffbox location (RR = 5.970, P < .05) were predictors of AVF thrombosis. When AVF location was excluded from the analysis, smoking (RR = 4.140, P < .01) and high blood eosinophil count (RR = 1.006, P < .005) were independent risk factors for thrombosis. Our study indicates that smoking and high blood eosinophil count may contribute to the development of AVF thrombosis.

Adult↗

PubMed2005

Vitamin D receptor BsmI and TagI gene polymorphisms in a Turkish ESRD population: influences on parathyroid hormone response.

BACKGROUND: Clinical presentation and complications of end-stage renal disease patients are influenced by many environmental and genetic factors. In this study we sought to define the frequencies of BsmI and TagI vitamin D receptor gene polymorphisms and their influences on clinical presentations in the Turkish end-stage renal disease population. METHODOLOGY AND PATIENTS: Hemodialyzed patients (n = 186; 111 male, 75 female) were genotyped for the insertion/deletion BsmI (B --> b, restriction site, exon VIII --> IX), TagI (T --> t, 352 exon IX) vitamin D receptor gene polymorphisms. The previous 12 months of laboratory values (C-reactive protein, intact parathyroid hormone, albumin, calcium, phosphorus, CaxP product) and clinical findings (vitamin D requirement, body weight) were analyzed retrospectively. RESULTS: Mean age and follow-up periods were 42.1 +/- 12.6 years and 76.3 +/- 43.9 months, respectively. Polymorphism percentages were BsmI; BB/Bb/bb: 28.9/65.3/5.8% and TagI; TT/Tt/tt: 36.7/60.5/2.8%, respectively. Further analysis revealed that the TT variant of TagI was related to hyperparathyroidism (P < .05). Analysis of the data after regrouping patients according to iPTH levels (0 to 249; 250 to 499; > or =500 pg/mL) and hemodialysis duration (<60 versus > or =60 months) revealed an influence of TT variation on hyperparathyroidism as a function of increased hemodialysis duration and higher iPTH levels (P < .005). CONCLUSION: TT variants of the TagI vitamin D receptor gene influence the development of hyperparathyroidism in hemodialysis patients, an influence that becomes more evident in patients with longer hemodialysis duration.

Deoxyribonucleases, Type II Site-Specific↗

PubMed2005

The role of early colonoscopy in CMV colitis of transplant recipients.

Cytomegalovirus (CMV)-associated diseases remain a major problem in transplant recipients. Early diagnosis is critical. Presentation of early CMV colitis can be mild and nonspecific in transplant recipients. Although serology is helpful in the diagnosis, sometimes it is inadequate. Because the endoscopic features of CMV colitis are specific, colonoscopy facilitates the histopathologic examination. We present the clinical properties and advantages of early colonoscopy in transplant recipients with CMV colitis. The study group included seven patients (six men, one woman of mean age, 36.7 years (range, 22 to 64 years) whose mean transplant duration was 12.3 months (range, 1 to 72 months). Six of the seven patients experienced an acute graft rejection treated with high doses of steroids; one patient had a herpes simplex virus infection. All patients were on steroid treatment with a various combinations of immunosuppressive agents, including cyclosporine, mycophenolate mofetil, and tacrolimus. All patients presented with mild diarrhea without any blood or mucous discharge. Four patients had fever exceeding 38 degrees C; two had abdominal pain. Stool examinations revealed normal findings in six patients, while one patient had white blood cells and amoebic cysts. Serum CMV IgM and CMV pp65 antigenemia were negative in five of seven patients and two had positive results. All patients showed typical colonoscopic and histopathologic findings compatible with CMV colitis. Standard ganciclovir treatment was successful in all patients. Early and rapid colonoscopy is beneficial for the early diagnosis and management of CMV colitis in transplant recipients.

Adult↗

PubMed2005

Risk factors for osteoporosis in young renal transplant recipients.

Osteoporosis is a frequent complication after renal transplantation. Although several risk factors have been defined in its pathogenesis, the parameters influencing this complication in young patients with functioning grafts have not been well defined. We sought to determine the possible risk factors for osteoporosis among 55 male and 27 female renal transplant patients of mean age 35.5 +/- 11.7 years with 68.8% recipients of living-related grafts. Bone mineral densitometry was performed in all patients at 1 year after transplantation. The study utilized the World Health Organization recommendations that define normal (group 1, n = 19), osteopenic (group 2, n = 24), or osteoporotic (group 3, n = 39) patients according to T-score values. Pre- and posttransplant data included gender, age at dialysis onset; age at transplantation; pretransplant dialysis duration; body mass index (BMI); serum calcium, albumin, phosphorus, parathyroid hormone (PTH), and C-reactive protein levels; lipid profile, cumulative doses of immunosuppressive drugs, and pulse steroid dose. Differences between groups 1 and 3 showed that patients with osteoporosis were younger (P < .003) and had started dialysis and underwent transplantation at a younger age than those without osteoporosis (P < .01, P < .003). In addition, pretransplant body weight (P < .02), posttransplant BMI (P < .01), and pretransplant PTH (P < .04), posttransplant total cholesterol, and high-density lipoprotein cholesterol levels were lower among group 3 (P < .004, P < .003). Young adults who started dialysis and underwent transplantation at a younger age were prone to osteoporosis. Additionally, high BMI and cholesterol levels seemed to be preventative for bone loss after transplantation.

Adult↗

PubMed2005

Pulse contour cardiac output system use in pediatric orthotopic liver transplantation: preliminary report of nine patients.

Anesthetic management of orthotopic liver transplantation (OLT) in pediatric patients is challenging in terms of intraoperative bleeding, fluid management, and hemodynamic monitoring. The pulse contour cardiac output (PiCCO) system, a relatively new device based on the single-indicator transaortic thermodilution technique, may be useful for intraoperative hemodynamic monitoring in pediatric patients. This is a preliminary report of PiCCO use in nine children (aged 9.8 +/- 4.7 years) undergoing OLT. Hemodynamic volumetric parameters monitored by the PiCCO system were mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index (ITBVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), and stroke volume variability (SVV). All parameters were recorded at anesthesia induction (T0), at the end of the anhepatic phase (Tanhepatic), and at the end of operation (Tend). The PiCCO system revealed similar MAP, CI, EVLWI, SVV, and SVRI values at all measurement intervals. Despite similar central venous pressure measurements, ITBVI values indicated significantly lower values at Tanhepatic than at T0 (627 +/- 160 mL/m2 and 751 +/- 151 mL/m2, respectively, P = .013). There were no PiCCO catheter-related complications in any patient. These findings demonstrate that the PiCCO system is a safe, continuous, multiparameter invasive monitoring device for use in pediatric patients undergoing OLT. This system may provide valuable data during pediatric OLT and appears to be a promising monitoring tool in these patients.

Adolescent↗

PubMed2005

Internal jugular versus subclavian vein catheterization for central venous catheterization in orthotopic liver transplantation.

The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein (IJV) versus the subclavian vein (SV) among 45 consecutive patients undergoing orthotopic liver transplantation (OLT) between January 2000 and June 2004. The subjects were divided into two groups according to the site of central venous catheterization (IJV or SV). We recorded each patient's physical characteristics, international normalized ratio (INR), partial thromboplastin time, platelet levels, number of puncture attempts, success/failure of central venous catheterization, duration of catheter placement, occurrence of catheter tip misplacement, arterial puncture, incidence of hematoma or pneumothorax, catheter-related infection, or bacterial colonization of the catheter. Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures. The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization. There were no significant differences between the groups with respect to success of central venous catheterization (100% for both), numbers of attempted punctures, duration of catheter placement, and incidence rates of mechanical and infectious complications. Both groups showed high frequencies of catheter tip misplacement, with right atrium as the site of misplacement in all cases. Two patients in the IJV group (8.7%) developed hematomas after accidental carotid artery puncture. The results suggest that, when performed by experienced anesthesiologists, central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT.

Adult↗

PubMed2005

The effect of graft nephrectomy on long-term graft function and survival in kidney retransplantation.

We retrospectively evaluated the long-term results of 53 (3.5%) recipients who received second allograft among 1486 kidney transplants between November 3, 1975 and June 30, 2004. Two study groups were patients in Group 1 (n = 21) who underwent allograft nephrectomy and those in Group 2 (n = 32) who did not. We assessed demographic features, rejection rates throughout the follow-up period, and serum creatinine levels at 12 months as well as graft and patient survival rates, postoperative complications, time interval between transplantations, and HLA matches. Forty-three patients who underwent retransplantation received kidneys from living-related donors and the remaining 10 from cadaveric donors. Mean serum creatinine levels of Group 1 versus Group 2 were 1.8 mg/dL (range, 0.8 to 6.6 mg/dL) versus 2.1 +/- 1.1 mg/dL (range, 1.1 to 7.1 mg/dL). HLA-AB and HLA-DR mismatches were 1.9 +/- 1.1 versus 1 +/- 0.6, respectively (P = .01). Acute rejection rates were not significantly different between Groups 1 (9/21, 43%) and 2 (12/32, 38%) (P < .05). The average intervals between the first and the second transplantations were 62 +/- 26 months in Group 1 (P = .02) and 32 +/- 11 months in Group 2. One-, 3-, and 5-year graft survival rates in Group 1 versus Group 2 were 83% versus 89% (P > .05); 64% versus 79% (P > .05), and 45% versus 68% (P = .04), respectively. In conclusion, we did not observe any advantage of graft nephrectomy before retransplantation. The length of the interval between the first and the second transplantations may have a negative correlation with second graft survival.

Adolescent↗

PubMed2005

Biliary complications and their management in pediatric liver transplantations: one center's experience.

Following living-donor liver transplantation, biliary complications are more prevalent among pediatric patients (<18 years old), with reported rates varying between 15% and 30%. In this study, we retrospectively analyzed biliary complications observed in 21 pediatric liver transplant patients (16 boys [76.2%], 5 girls [23.8%] of ages 1 to 18 years (mean, 8.3 +/- 5.05 years) between September 2001 and June 2004. Biliary reconstruction was accomplished via a duct-to-duct anastomosis in 12 (57.1%) and a Roux-en-Y hepaticojejunostomy in 9 (42.9%) patients. Postoperative biliary complications were encountered in six (28.5%) patients. Four of the biliary leaks were from a duct-to-duct anastomosis and two from an hepaticojejunostomy. One (4.7%) patient who experienced biliary leakage after a duct-to-duct anastomosis developed stenosis after the leak healed; five (23.8%) had the leakage treated successfully. One patient had biliary leakage from the duct-to-duct anastomosis subsequent to a hepatic artery thrombosis. All patients with biliary leakage were treated without surgery. Mean follow-up time was 10.2 +/- 9.6 months (range, 1 to 26 months). Three patients died during follow-up; however, these deaths were not related to the biliary complications. Interventional radiologic approaches are effective to biliary complications, even when the anastomoses are heavily disrupted. In cases of biliary complication, percutaneous combined with internal drainage may prevent biliary sepsis and provide long-term patency.

Adolescent↗

PubMed2005

Intra- and postoperative complications of donor nephrectomies.

INTRODUCTION: Living-donor renal transplantation has become common worldwide. However, living-donor nephrectomy is not a complication-free procedure. This retrospective study reviews the intra-and postoperative risks and complications of donor nephrectomies at our institution between 1994 and 2002. METHOD: Two hundred fifty-seven consecutive donor nephrectomy patients were evaluated using medical records and anesthetic charts. RESULTS: The mean age of living donors was 42 +/- 12 years: 19 were older than 61 years, and 143 (55.6%) were women. Anesthesia for donor nephrectomy included general anesthesia, combined spinal-epidural anesthesia (CSE), general + CSE, and general + epidural anesthesia. We observed 51 intra- and postoperative complications in 26 patients. The minor complication rate was 10.1%. The duration of surgery was 3.56 +/- 0.26 hours (range, 2 to 5 hours). Serum creatinine levels were increased significantly (P < .05) on postoperative days 1, 3, and 5 compared with the preoperative levels (P < .05). There was no mortality. CONCLUSIONS: Like other surgical operations, living-donor nephrectomy is associated with intra- and postoperative complications. Although these complications are minor, maximal efforts must be applied in the anesthetic approach to minimize donor complications, and donors should be informed about potential risks.

Adult↗

PubMed2005

The history and activities of transplantation in Turkey.

The cornerstone events of transplantation history in Turkey are summarized herein. In 1975, we performed the first living-related renal transplant in Turkey. This was followed in 1978, by the first deceased donor kidney transplantation, using an organ supplied by Eurotransplant. In 1979 the law on harvesting, storage, grafting, and transplantation of organs and tissues was enacted; later that year, the first local deceased donor kidney transplantation was performed by our team. In 1988, another groundbreaking event in Turkey was successfully achieved; the first cadaveric liver transplantation; and in 1990, the first pediatric living-related segmental liver transplantation in Turkey and in the region by our team. One month later, an adult-to-adult living-related liver transplantation was successfully performed. Until now, we have performed 1506 kidney and since 1988, 121 liver transplantations. During 29 years of solid organ transplantation history in Turkey, 6686 kidney transplants have been performed nationwide in 28 different centers; 696 livers; 13278 corneas; 2883 bone marrow; 132 hearts; and 15 pancreas transplants. In 2001, the health ministry established the National Coordination Center as an umbrella organization to promote transplantation activities, especially for deceased donor organ procurement. Transplantation activities are accelerating day by day all around the country, but deceased donors are still far below the desired rates. Improvements in the fields of education and coordination should increase the quality and the quantity of transplantation activities.

Adult↗

PubMed2005

Potential effects of 1,25-dihydroxyvitamin D3 in renal transplant recipients.

Besides its effects on bone metabolism, calcitriol has an important immunomodulatory effect, which may be protective for a renal allograft. Therefore, we evaluated the effects of oral calcitriol administration in renal transplant recipients. One hundred ten renal transplant recipients (78 men, 32 women) of mean age 35.2 +/- 11.4 years and mean posttransplantation follow-up of 50.7 +/- 22.9 months were entered into the study. Patients in group 1 (n = 57) received calcitriol therapy and patients in group 2 (n = 53) did not. The mean start of calcitriol therapy was 22.4 +/- 19.1 months posttransplantation. We restrospectively collected pretransplantation and posttransplantation laboratory and clinical data as well as creatinine levels before and after the initiation of calcitriol therapy at 6-month intervals for 2 successive years. There were no significant differences in terms of age, gender, immunosuppression, bone mineral densitometry, and follow-up. Our results showed that patients in group 1 had lower pretransplantation and postransplantation body mass index (P < .03; P < .03, respectively), lower posttransplantation third year parathyroid hormone levels (P < .02), and lower requirements for pulse steroid doses (P < .04). Using Friedman repeated measures variance test to analyze the effect of calcitriol, the increase in creatinine levels was significantly lower in group 1 (P < .04). There was no significant difference between follow-up time and calcitriol dose (P > .05). In conclusion, calcitriol therapy may reduce the rate of loss of renal function among patients receiving renal transplants.

Adult↗

PubMed2005

OKT3 treatment for steroid-resistant acute rejection in kidney transplantation.

Orthoclone (OKT3, Ortho Biotech Inc, USA) monoclonal antilymphocyte antibody is a powerful T-cell-specific immunosuppressive agent. OKT3 has been used for induction therapy in kidney and liver transplantation, as well as to treat acute or steroid-resistant acute rejection episodes (ARE). This study was a retrospective analysis of 43 renal transplant recipients who developed steroid-resistant ARE and were treated with OKT3 between September 1994 and June 2004. The recipients were 36 men and 7 women of mean age 32.7 +/- 11.6 years (range, 19 to 48 years). The mean time from transplantation to OKT3 treatment was 7.2 +/- 6.7 months. Thirty-four episodes (79.1%) responded to OKT3 therapy with improved graft function, but the remaining 9 (20.9%) grafts did not respond. Among the 34 OKT3 responders, the mean serum creatinine decreased from 3.96 +/- 2.5 mg/dL to 2.45 +/- 1.77 mg/dL after treatment. Eleven (25.6%) of the 43 patients experienced minor side effects: fever, dyspnea, tachycardia, bradycardia. One patient (2.3%) developed acute pulmonary edema; one (2.3%), cytomegalovirus infection; and eight (18.6%), bacterial infections. The 1-, 3-, and 5-year graft survival rates for the 34 patients who responded to OKT3 therapy were 96%, 93%, and 85%, respectively. All patients are currently alive. The results indicate that OKT3 is a safe, effective treatment choice for steroid-resistant ARE in kidney transplantation.

Acute Disease↗