No abstract available.
Kidney Transplantation* ; Muromonab-CD3*

Aseptic meningitis may rarely occur with the use of OKT3 murin monoclonal antibody, which is an immunosuppressive agent for the prevention and treatment of acute rejection in solid transplantation. We present a patient with aseptic meningitis, developed during OKT3 therapy, who shows characteristic clinical features and CSF findings consistent with OKT3 associated aseptic meningitis.
Humans ; Meningitis, Aseptic* ; Muromonab-CD3*

The study was performed to measure and compare the peripheral blood T cell and T subsets in normal controls and psoriatic patients. Thirty-two normal controls and fift:en psoriatic patients were subjected to the study and the percentages and the rati vs of peripheral blood T cell and T subsets were measured. The results were as follows: 1. Mean percentages of peripheral blood lymphocytes reactive with OKT3 monoclonal antibody in psoriatic patients were 72. 8+-8. 2%, They decreased significantl) as compared with these in control group(76, 6- i-4. 7%). Mc an percentages of peripheral blood lymphocytes reactive with OKT4 monoclonal antibody in psoriatic patients were 47. 3+6, 7p;. They increased as compared with these in control group(46. 5+-3. 9p;), but the increase was insignificant. 3. Mean percentages of peripheral blood lymphocytes reactive with OKT8 monoclonal antibody in psoriatic patients were 27. 2+5. 5g, They decreased significantly as compared with these in control group(30, 6- l-4. 3%) 4. Mean ratios of lymphocytes reactive with OKT4 monoclonal antibody to these reactive with OKT8 monoclonal antibody in psoriatic patients were 1.8+- 0. 48 They increased significantly as compared with these in control group(1. 6+ 0.34).
Allergy and Immunology ; Humans ; Lymphocytes ; Muromonab-CD3 ; Psoriasis

BACKGROUND: Steroid pulse therapy has been used for patients with acute rejection after kidney transplantation. The ABCB1 gene codes for P-glycoprotein, a transporter that is involved in the metabolism of steroids. However, the role of ABCB1 polymorphisms has not been investigated in patients with acute rejection after kidney transplantation. METHODS: Among 763 patients that received kidney or simultaneous pancreas-kidney transplantation at Seoul National University Hospital between May 1996 and July 2009, 684 patients agreed to genetic sampling for polymorphisms. Acute rejection was defined as biopsy-proven, acute cellular rejection with increased serum creatinine, or in the context of delayed or slow graft function. Steroid-resistance was defined as no improvement in serum creatinine, need for additional OKT3 or ATG treatment, or repeated acute rejection within 30 days. Three polymorphisms of ABCB1 gene (C1236T, C3435T, G2677T/A) were assessed. RESULTS: C allele frequency of C3435T was 59.3% and of C1236T 40.1%. Patients who were steroid-resistant (n=37) had higher serum creatinine at kidney biopsy compared to those who were steroid-sensitive (n=49, P<0.001). The frequency of ABCB1 gene polymorphisms (C1236T and C3435T) did not differ significantly between patients who were steroid-sensitive and those who were resistant. An association with G2677T/A could not be analyzed due to a high failure rate of genotyping. CONCLUSIONS: ABCB1 gene polymorphisms (C1236T and C3435T) were not associated with steroid resistance in patients with acute cellular rejection after kidney transplantation.
Biopsy ; Creatinine ; Gene Frequency ; Humans ; Kidney ; Kidney Transplantation ; Muromonab-CD3 ; P-Glycoprotein ; Rejection (Psychology) ; Steroids ; Transplants

Hemolytic uremic syndrome (HUS) after renal transplantation is infrequent but, severe complication of kidney transplantation. Cyclosporine (CyA) or Tacrolimus-induced microangiopathy may be the causative factor in posttransplant HUS. Early diagnosis of the syndrome and discontinuation of cyclosporine or tacrolimus occasionally led to reversal of the syndrome. Many therapeutic trials with variable maintenance immunosuppression protocols were proposed, but, there were no confirmed strategies to manage the posttransplant HUS. We present a case of de novo cyclosporine associated HUS occurring within first a few days after renal transplantation. Early diagnosis was done with presence of shistocytes in peripheral blood smear, thrombocytopenia, low haptoglobin, and renal dysfunction. Supportive therapy with OKT3 immunosuppression followed by mycophenolate mofetil (MMF) and prednisolone (Pds) maintenance therapy led to reversal of renal dysfunction and remission of HUS. In conclusion, in transplant recipients receiving CyA who suffer from HUS, MMF-based dual therapy may be considered. Maintenance treatment with MMF and Pds may be of benefit to more transplant recipients such as those suffering from other CyA or tacrolimus-related side effects.
Cyclosporine ; Early Diagnosis ; Haptoglobins ; Hemolytic-Uremic Syndrome* ; Immunosuppression ; Kidney Transplantation* ; Kidney* ; Muromonab-CD3 ; Prednisolone* ; Tacrolimus ; Thrombocytopenia ; Transplantation

Acute rejection in renal transplantation is a major risk factor threatening the longterm graft survival. Acute rejections refractory to conventional anti-rejection therapy using steroid pulse or antilymphocyte preparations occur in minority, preceding to progressive deterioration of renal function and graft loss. Recent reports showed that tacrolimus rescue therapy in this refractory rejections has converted rejection process. In order to evaluate the clinical outcome of tacrolimus rescue therapy in refractory rejections, we performed a retrospective study. Since April 1997, we performed tacrolimus rescue therapy intent-to-treat for steroid- or OKT3- resistant rejections in 5 patients. All rejections were histologically confirmed according to Banff criteria. As conventional antirejection therapy, steroid pulse therapy (solumedrol 500~1000 mg iv for 3 days) or OKT3 therapy (5 mg/day for 14 days) was performed. The outcome of the rescue therapy is classified into three categories by the change of serum creatinine level or the histologic findings; Improvement-return of serum creatinine level (sCr) to or below the prerejection baseline (nadir) level, Stabilization-arrested sCr increase, Failure-progressive deterioration of renal function, or graft loss. All were men and the mean age was 38 years. Living related- & unrelated-donor transplantation were 2 and 3 cases respectively. Immunosuppression were done with CsA Pd+ (3) or CsA+ Pd+ AZA (2). Acute rejection grades according to Banff criteria were mild (2) or moderate (3). The mean interval between transplantation and tacrolimus conversion was 54.4 days. The outcome was as follows; improvement 2 cases, stabilization 1 case and failure 2 cases. During 3~10 months followup PTLD occured in 1 case, treated with graft nephrectomy and no other complications in other 4 cases. In conclusion, we can convert ongoing refractory rejections to steroid and OKT3 therapy by tacrolimus rescue therapy in 60% (3/5) successfully. Although longterm followup result is necessary to confirm the efficacy and safety of the tacrolimus rescue therapy, the result of this early trial is so good that we may try tacrolimus in refractory rejections for rejection reversal.
Creatinine ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Male ; Muromonab-CD3 ; Nephrectomy ; Retrospective Studies ; Risk Factors ; Tacrolimus* ; Transplants

Mycophenolate mofetil (MMF) is a novel new immunosuppressant which suppress proliferation of T and B lymphocytes by inhibiting inosine monophosphate dehydrogenase. Even though the results we can get now are still preliminary but the positive result such as low incidence of acute rejection episode, is very attractive to clinical therapist. It also has certain effect on rescue therapy of steroid resistant acute rejection. There is little proven report of long-term follow up of this drug but the improvement of early graft survival suggest better long-term result. From March 1997, we used MMF as one of the primary immunosuppressant with cyclosporine and steroid in 47 renal allograft recipient (MMF group) and the early result of this protocol is compared with control group using conventional two drug regimen (cyclosporine and steroid)in 96 recipients. The 2 g of MMF were given daily from 2nd post-transplant day. The acute rejection episode within 3 and 6 months are 12.1 and 12.8% in MMF group and these are statistically significant difference with the results of control group (36.5% and 38.5% respectively, P<0.005). The response rate of acute rejection to steroid pulse therapy was 66.7% in MMF group but has no statistical difference with that of conventional group (84.1%). Steroid resistant severe acute rejection that needed to use OKT3 was developed in 1 case (2.1%) in MMF group but 7 (7.3%) in control group. Among the complication, post-transplant infection occurred in 6 cases (12.8%) of MMF group but in 8 cases (8.3%) in control group. Diarrhea that needed medication developed in 8 cases of MMF group (17.0%), but only one of them is necessary to change his immunosuppressive regimen. Leukopenia also developed in 1 case of each group. In summary, the incidence of acute rejection episode and steroid resistant rejection that is necessary to use OKT3 is significantly decreased in MMF group but the response rate to steroid pulse therapy and complications of both groups showed no statistical difference.
Allografts* ; B-Lymphocytes ; Cyclosporine ; Diarrhea ; Graft Survival ; Incidence ; Inosine Monophosphate ; Kidney Transplantation ; Kidney* ; Leukopenia ; Muromonab-CD3 ; Oxidoreductases

Although the outcome and the possibility of renal recurrence of disease in systemic lupus erythematosus is still a matter of controversy, kidney transplantation is generally regarded as a proper indication for the treatment of patients with end stage renal failure caused by systemic lupus erythematosus. Hemolytic uremic syndrome is characterized by the symptoms of sudden onset of hemolytic anemia, thrombocytopenia, and deteriorating renal function. Many patients with postrenal transplantation hemolytic uremic syndrome have lost their grafts because of no known established treatment modality. Although the substitution of cyclosporine to FK506 is reported as a successful strategy for the treatment of cyclosporine associated hemolytic uremic syndrome in many reported cases, we cannot find the constant reports because FK506 or even OKT3 is also known as the cause of postrenal transplantation hemolytic uremic syndrome. But cyclosporine associated hemolytic uremic syndrome can be treated by the proper choice of immunosuppressant and conservative treatment. In this report, a patient with end stage renal failure caused by systemic lupus erythematosus experienced cyclosporine associated postrenal transplantation hemolytic uremic syndrome. He has recovered from the symptoms by withdrawal of cyclosporine and reduced dose of FK506 and at the same time, conservative treatment. We report this case with literature review.
Anemia, Hemolytic ; Cyclosporine* ; Hemolytic-Uremic Syndrome* ; Humans ; Kidney Transplantation ; Lupus Erythematosus, Systemic* ; Muromonab-CD3 ; Recurrence ; Renal Insufficiency* ; Tacrolimus ; Thrombocytopenia ; Transplants

Adult ; Graft Rejection ; drug therapy ; Humans ; Immunosuppressive Agents ; therapeutic use ; Liver Transplantation ; Male ; Middle Aged ; Muromonab-CD3 ; therapeutic use

PURPOSE: CD25 monoclonal antibody (basiliximab, BA) has been reported an excellent effect on induction immunosuppression than ALG, ATG, OKT3 in renal transplantation. Since we can use BA only in the group of high risk kidney recipient, we want to evaluate the effect of BA treated group by comparing with conventional 3 drugs combination group (calcineurin inhibitor/cyclosporine or tacrolimus, mycophenolate mofetil and prednisolon). METHODS: Total 103 recipients were treated by BA and conventional 3 drugs from March 2000 through February 2006, and these cases were compared with 122 recipients without BA. Government guidelines for using BA were in cadaveric transplantation, more than 4 HLA mismatching, zero DR antigen matching, retransplantation and more than 80% positive PRA. The episode of acute rejection (AR), steriod resistant acute rejection, change of serum creatinine, maintaining dosage of calcineurin inhibitor (CNI) and other side effects were compared between groups. RESULTS: The rate of AR within 12 months after transplantation was 11.7% in BA group while 9.0% in control group (P=0.451). The steroid resistant acute rejection was 16.6% in BA group and 27.3% in control group (P=0.119). Rejection free graft survival adjusted various clinical risk factors by Cox-regression test were no significance between groups. Serum creatinine level at one year after transplantation was 1.61+/-.1 and 1.46+/-.7 mg/dL in BA and control group, and recipients number whose SCr over 1.5 mg/dL were 39.0% and 32.7% (P=0.326). Cyclosporin dosage at one year in BA and control group were 4.21 and 3.62 mg/kg (P=0.202) and 0.11 and 0.17 mg/kg in tacrolimus group (P=0.291). Incidence of PTDM and viral infection were all no difference statistically between groups. CONCLUSION: In conclusion, BA induction immunosuppression with CNI, mycophenolate mofetil and prednisolon used in high risk kidney recipient effectively control the acute rejection and steroid resistant acute rejection for one year at least the same as control group. But since there was no more beneficial effect in BA added to Tac group than conventional Tac based immunosuppression, this 4 drug combination is better avoided if possible.
Cadaver ; Calcineurin ; Creatinine ; Cyclosporine ; Graft Survival ; Immunosuppression ; Incidence ; Kidney Transplantation ; Kidney* ; Muromonab-CD3 ; Risk Factors ; Tacrolimus ; Transplantation