移植技术与研究

In organ transplantation, a wide variety of injurious events such as ischaemia-reperfusion injury, endothelial damage and the traumatic exposure of tissues during surgery occur intra-operatively. The barrage of multiple antigens presented to the recipient cause very intense immunological reaction to occur at the time of transplantation. Thus, an induction immunosuppressive protocol aimed at maximal immunosuppression in the peri-operative period when immunological stimulation is maximal is justified.

Organ transplant recipients of African descent are generally considered as high immunological-risk patients in view of the intense immunological response to transplanted organs seen in these patients compared with their Caucasian counterparts. However, due to the huge additional cost of induction antibody medications, most centers in resource-poor economies in Africa base their induction protocol on high doses of calcineurin based triple-drug therapy. Outcomes from the centers have been considerably poorer in terms of allograft rejection, graft loss and patient survival, compared with other parts of the world where high-risk patients received antibody induction therapy.

Basiliximab induction protocols may offer cost–benefit advantages in resource constrained centers compared with currently used calcineurin based triple-drug therapy. The clinical and financial benefits of reduced acute allograft rejection rates, graft loss and the excellent side effect profile Basiliximab in renal transplant recipients, potentially outweighs the additional costs incurred in the management of higher acute rejection rates, and graft loss in calcineurin based triple-drug therapy.

This reflective review article, examines the possible role of Basiliximab induction protocol as a means of improving clinical outcomes of renal transplantation, in African transplant centres operating in financial constraint economies.

Background: Cardiovascular disease is a major cause of morbidity and mortality after kidney transplantation. Endothelial dysfunction was shown to constitute an independent predictor of cardiovascular events. This study aimed at detecting endothelial dysfunction in pediatric renal transplant recipients.

Methods: This was a prospective cohort study of 36 pediatric renal transplant recipients during their first posttransplantation year (transplantation group), 30 patients with end stage renal disease (ESRD) on regular hemodialysis (HD) (dialysis group) and 30 normal subjects (control group). Doppler ultrasound was performed for assessment carotid artery intima-media thickness (IMT) and brachial artery flow-mediated dilatation (FMD).

Results: Carotid artery IMT measurements in the transplantation group (mean ± SD = 0.43 ± 0.08 mm) were significantly (p=0.001) lower than the dialysis group (0.5 ± 0.1mm) and insignificantly higher than the control group (0.41 ± 0.07mm). FMD was significantly impaired in the dialysis group. The median (IQR) FMD of the transplantation group, 8.7% (2.5-20.4), tended to be higher than that of the dialysis group, 4.4% (2.6-10.8) and lower than that of normal controls, 14% (8.5-19.7); p=0.055 and 0.12 respectively.

Conclusion: Pediatric renal transplant recipients tend to show evidence of endothelial dysfunction at an apparently lesser extent than those on regular hemodialysis.