Showing papers by "Amir Kazory published in 2004"
TL;DR: Nontraditional cardiovascular risk factors greatly contribute to increased incidence of ischemic heart disease events in renal transplant recipients and should be considered in preventive care of these patients which relies on reduction of overall absolute risk.
160 citations
TL;DR: In renal transplant recipients, induction therapy with Thymoglobulin seems to be associated with a significantly greater incidence of CMV disease, malignancy, and death compared with ATGF.
Abstract: Background Antithymocyte globulin (ATG) preparations are frequently used as induction treatment in renal transplantation, but little is known about the clinical equivalence of these different agents. We performed a retrospective, single-center study to compare the long-term clinical effects of ATG Fresenius (ATGF) and Thymoglobulin (SangStat, Fremont, CA) in renal transplant recipients. Patients and methods A total of 194 consecutive renal transplant recipients were included who had undergone transplantation in our center between June 1993 and April 2001 and had received ATGF or Thymoglobulin as induction treatment. Results A total of 129 patients received ATGF and 65 patients received Thymoglobulin. Thirty patients (23%) in the ATGF group demonstrated cytomegalovirus (CMV) disease, whereas 24 patients (37%) in the Thymoglobulin group demonstrated CMV (P =0.02). Five patients (3.9%) in the ATGF group and eight patients (12.3%) in the Thymoglobulin group developed posttransplant malignancy (P =0.01). Five patients (3.9%) in the ATGF group and nine patients (13.8%) in the Thymoglobulin group died during follow-up (P =0.005). Cox regression analysis revealed that Thymoglobulin was an independent predictor of CMV disease (relative risk [RR] 2.16, confidence interval [CI] 95% [1.04-4.48]), malignancy (RR 2.16, CI 95% [1.04-4.48]), and death (RR 4.14, CI 95% [1.36-12.6]). Conclusion In renal transplant recipients, induction therapy with Thymoglobulin seems to be associated with a significantly greater incidence of CMV disease, malignancy, and death compared with ATGF.
59 citations
TL;DR: The clinical aspects and controversies of the most important of these factors including immunosuppressive agents, antiphospholipid antibodies, hyper-homocysteinemia, pre-transplant dialysis modality, and post-trans transplant erythrocytosis are reviewed.
Abstract: Stable renal transplant recipients manifest a chronic hypercoagulable state with an increased risk of thromboembolic complications, which appears to be multifactorial. While this group of patients could present the known risk factors for thromboembolism in the general population (e.g. diabetes, cancer, pregnancy), they may also suffer from other situations which are mostly related to transplantation and are consequently specific to them. Here, we review briefly the clinical aspects and contro-versies of the most important of these factors including immunosuppressive agents, antiphospholipid antibodies, hyper-homocysteinemia, pre-transplant dialysis modality, and post-transplant erythrocytosis. In addition, other more recent topics including hypercysteinemia, recurrent proteinuria, and acute CMV infection are discussed.
59 citations
TL;DR: Seven cases of simultaneous acute CMV infection and venous thromboembolism in renal-transplant recipients are presented and a potential causative effect is suggested.
Abstract: Renal-transplant recipients have a higher prevalence of thromboembolic events compared with the general population. This elevated risk has been attributed to immunosuppressive drugs as well as metabolic and immunologic factors. Cytomegalovirus (CMV) infection, a frequent complication of transplantation, is known to modify endothelial phenotype from anticoagulant into procoagulant. There are few reports addressing the association of venous thromboembolism with CMV infection in immunocompetent patients. Some authors have also reported cases of arterial thrombosis in transplant recipients presenting CMV infection. However, the association of venous thromboembolic events with CMV infection has not yet been discussed in these patients. We present seven cases of simultaneous acute CMV infection and venous thromboembolism in renal-transplant recipients and suggest a potential causative effect.
44 citations
TL;DR: Two patients who had undergone surgical resection of the cutaneous lesion along with antifungal treatment and had a previous history of a mild traumatic event with a stretcher that could have potentially served as the reservoirs and vectors for the transmission of the fungus are reported.
Abstract: We report two cases of cutaneous alternariosis in renal transplant recipients. The diagnosis was made by mycologic and histologic examination. The patients were treated with itraconazole. In one patient who had undergone surgical resection of the cutaneous lesion along with antifungal treatment, the follow-up period was uneventful with no signs of recurrence. In the other patient, surgical excision of the lesion was not performed prior to antifungal therapy. The lesion disappeared following treatment but local recurrence was observed 1.5 years later with an unfavorable evolution despite administration of the second course of therapy. Resection of the lesion and prolongation of the treatment resulted in a satisfactory course with no signs of local recurrence over a follow-up period of 4.5 years. Interestingly, both of the patients had a previous history of a mild traumatic event with a stretcher in our outpatient clinic where the follow-up visits were made. A vast mycologic survey was then made in our department, which disclosed that some of the stretchers were contaminated by the fungi and could have potentially served as the reservoirs and vectors for the transmission of the fungus.
15 citations
3 citations
TL;DR: Reports indicate that nonBKV PVN, though rare, does exist and the hypothesis that JCV and SV40 could induce PVN independent of BKV would not then seem surprising.
Abstract: Nearly all reported cases of PVN in the literature are caused by BKvirus (BKV). PVN has therefore traditionally been considered somehow synonymous with BKV nephropathy. However, some facts should be reviewed regarding the etiologic agent responsible for PVN: F|rst, the three polyomaviruses, namely BKV, JC virus (JCV), and Simian virus-40 (SV40), are very similar in structure, with 70^72%DNA sequence homology. Second, JCV has been shown as a co-infectious agent in the kidney of a subset of renal transplant recipients with established BKVnephropathy (1); molecular evidence of co-infection with BKVand SV40 has also been shown in some renal transplant recipients with established PVN (2). Third, BKV and SV40 have been reported to cause progressive multifocal leukoencephalopathy, although the overwhelming majority of cases are caused by JCV (3). These facts indicate that these three polyomaviruses, which share many structural similarities, might also be capable of inducing similar pathologic patterns. The hypothesis that JCV and SV40 could induce PVN independent of BKVwould not then seem surprising. Indeed, recent ¢ndings are in agreement with this hypothesis. Our team has recently reported a case of JCV-induced allograft nephropathy in a renal transplant recipient in the absence of BKV (4), and very recently SV40 has been reported as the single agent causing PVN without any biological stigmata of BKV or JCV infection (5). These reports indicate that nonBKV PVN, though rare, does exist.
3 citations
TL;DR: Cytomegalovirus infection is reported to be capable of modifying endothelial surface with subsequent increased risk of thromboembolic complications and two renal transplant recipients who manifested severe coagulation disorders associated with acute CMV infection are reported.
Abstract: Cytomegalovirus (CMV) infection is reported to be capable of modifying endothelial surface with subsequent increased risk of thromboembolic complications. Nevertheless, there are only sparse reports on its role in the development of bleeding diathesis. Here we report two renal transplant recipients who manifested severe coagulation disorders associated with acute CMV infection. Antiviral therapy was followed by consistent correction of coagulation abnormalities.
2 citations
1 citations