Background. Hyperhomocysteinemia is an independent risk factor for the development of cardiovascu... more Background. Hyperhomocysteinemia is an independent risk factor for the development of cardiovascular conditions in chronic stable renal-transplant recipients (RTR). Major determinants of plasma total homocysteine (tHcy) in RTR are renal function and folate levels. The data dealing with the possible regulation of the tHcy metabolism by insulin and nutritional status is conflicting in non-transplant populations. Methods. We examined the relationship between tHcy, insulin and nutritional status in 103 chronic, stable RTR. Demographic, clinical, and biochemical parameters were assessed for each patient. Results. Mean tHcy was 19.7"9.2 mmolul (range 8.6–53). The tHcy was strongly related to creatinine clearance (rs0.55, P-0.0001). Fasting tHcy levels were negatively related to folate concentrations (rs 0.32, Ps0.01). There was a positive relationship between tHcy and LDL-cholesterol (rs0.34, Ps0.03) and a significant negative correlation between tHcy and insulin (rs 0.38, Ps0.01). F...
Annals of transplantation : quarterly of the Polish Transplantation Society, 2001
Cardiovascular disease (CVD) is one of the leading cause of mortality in renal transplant recipie... more Cardiovascular disease (CVD) is one of the leading cause of mortality in renal transplant recipients. Authors review accepted CVD risk factors. The role of additional factors like increased homocysteine level is discussed.
Cyclosporin withdrawal with concomitant conversion from azathioprine to mycophenolate mofetil in ... more Cyclosporin withdrawal with concomitant conversion from azathioprine to mycophenolate mofetil in renal transplant recipients with chronic allograft nephropathy: a 2-year follow-up The results presented in this paper have not been published previously in whole or part except in abstract form. This work was presented as an oral communication at the EDTA XXXVIIth congress and has received an award from the EDTA.
Hypertension is highly prevalent in the dialysis population, and has been implicated in the patho... more Hypertension is highly prevalent in the dialysis population, and has been implicated in the pathogenesis of the observed excess of cardiovascular morbidity and mortality in these patients. Nevertheless, there are no reports on the clinical and biochemical determinants of both pulse pressure (PP) and mean arterial pressure (MAP) in dialysis populations. A total of 541 haemodialysed patients from 11 dialysis centres were included in the study. The demographic, clinical, and biological characteristics were recorded. Both pre- and post- dialytic blood pressures (systolic and diastolic) were measured. PP and MAP were calculated. Mean predialytic PP was 67 +/- 17 mm Hg and significantly decreased after dialysis (60 +/- 18 mm Hg; P < 0.0001). In multivariate analysis, a 10 mm Hg increase in PP was positively associated with age (RR, 2.01; 95% CI, 1.35-5.01, for a 10-year increase in age), diabetes mellitus (RR, 1.08; 95% CI, 1.04-1.14), interdialytic weight gain (IWG) (RR, 1.84; 95% CI, 1.07-3.18, for 1% increase in IWG), and current smoking (RR, 2.59; 95% CI, 1.13-5.92) and negatively with Hb concentration (RR, 0.92; 95% CI, 0.84-0.99, for a 1 g/100 ml in Hb). Mean predialytic MAP was 98 +/- 15 mm Hg and significantly decreased after dialysis (91 +/- 16 mm Hg; P < 0.0001). In multivariate analysis, a 10 mm Hg increase in MAP was positively associated with parathyroid hormone (PTH) (RR, 1.32; 95% CI, 1.15-1.6, for 50 ng/ml in PTH), erythropoietin (EPO) treatment (RR, 1.09; 95% CI, 1.03-1.16), and current smoking (RR, 1.87; 95% CI, 1.39-2.41). PP and MAP are associated with different clinical parameters. Most of these factors are potentially reversible. Smoking cessation, correction of anaemia and limitation of IWG should be important challenges for physicians in care of dialysis patients.
The high incidence of cardiovascular disease in hemodialyzed (HD) patients is well established an... more The high incidence of cardiovascular disease in hemodialyzed (HD) patients is well established and oxidative stress has been involved in this phenomenon. The aim of our study was to evaluate if a vitamin E-coated dialyzer could offer protection to HD patients against oxidative stress. Sixteen HD patients were successively assessed for one month (i) on a high biocompatible synthetic dialyzer (AN) and (ii) on a vitamin E-coated dialyzer (VE). Blood samples were taken before and after the dialysis session at the end of each treatment period. HD session conducted with the AN dialyzer was responsible for acute oxidative stress, significantly assessed after HD by a decreased plasma vitamin C level and an increased ascorbyl free radical (AFR)/vitamin C ratio used as an index of oxidative stress. Plasma elastase activity, reflecting neutrophil activation, was also increased; soluble P-selectin, reflecting platelet activation, did not show any variation. The use of the VE dialyzer was associated with a less extended oxidative stress compared with the AN membrane: basal vitamin C level was higher, and after the HD session AFR/vitamin C ratio and elastase activity were not significantly increased. Plasma vitamin E levels were not affected. Our study demonstrates that HD is associated with oxidative stress, which can be partially prevented by the use of a vitamin E-coated dialyzer. Our data suggest that this dialyzer may exert a site-specific scavenging effect on free radical species in synergy with a reduced activation of neutrophils.
Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this s... more Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this study, we investigated whether lymphocyte subset count could predict the risk of developing noncutaneous neoplasia (NCSC) in renal transplant recipients (RTR). Between January 1995 and December 1995, lymphocyte subsets (CD4, CD8, CD19) were measured in 28 1 RTR. This population was studied until November 1999 for the development of NCSC. The mean follow-up was 42 k 9 months. Neoplasm was diagnosed in 22 patients (7.9%). Patients who developed a cancer were significantly older (53.8 * 6 years vs 38 & 16 years, P < O.OOOl), had lower CDq (234 f 126/mm3 vs 543 i214/pm3, P < 0.005) and CD19 (19 k 9/mm3 vs 51 * 22/mm3, P < 0.0001) levels, and
Antiphospholipid antibodies as a risk factor for atherosclerotic events in renal transplant recip... more Antiphospholipid antibodies as a risk factor for atherosclerotic events in renal transplant recipients.BackgroundEpidemiologic studies reported that antiphospholipid antibodies (APAs) were independent predictors of atherosclerotic events. We recently reported a high prevalence of APAs in renal transplant recipients. Nevertheless, the role of APAs on atherosclerotic events has not been prospectively studied in this high-risk population.MethodsParticipants in the study were 324 consecutive
Because recent large studies have demonstrated that mycophenolate mofetil (MMF) is superior to az... more Because recent large studies have demonstrated that mycophenolate mofetil (MMF) is superior to azathioprine (AZA) as a posttransplant immunosuppressant, it has been speculated that MMF could have a cyclosporin (CsA)sparing effect in renal transplant recipients with chronic allograft dysfunction. Between April 1996 and October 1998, 31 patients with chronic allograft dysfunction were assigned to have conversion from AZA to MMF with concomitant CsA withdrawal. Patient and graft outcomes were analysed. Mean follow-up time after MMF conversion was 27 * 11 months. Serum creatinine concentration (sCt) significantly decreased after conversion and remained stable at the end of followup (227 * 3 1 pmol/l vs. 185 It 50 pmol/l; P < 0.0005). Mean variation in sCt was -24% after conversion, whereas it was +20% in the year before conversion ( P < 0.001). There was a significant inverse relationship between proteinuria at baseline and improvement in renal function (r = -0.35; P = 0.01). Proteinuria increased during follow-up (0.79 It 0.6 vs.
Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this s... more Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this study, we investigated whether lymphocyte subset count could predict the risk of developing noncutaneous neoplasia (NCSC) in renal transplant recipients (RTR). Between January 1995 and December 1995, lymphocyte subsets (CD4, CD8, CD19) were measured in 28 1 RTR. This population was studied until November 1999 for the development of NCSC. The mean follow-up was 42 k 9 months. Neoplasm was diagnosed in 22 patients (7.9%). Patients who developed a cancer were significantly older (53.8 * 6 years vs 38 & 16 years, P < O.OOOl), had lower CDq (234 f 126/mm3 vs 543 i214/pm3, P < 0.005) and CD19 (19 k 9/mm3 vs 51 * 22/mm3, P < 0.0001) levels, and more frequently had past histories of skin cancer (24% vs 4%, P < 0.01). Cox regression revealed that high CD4 levels (RR 0.73, 95% CI 0.62-0.89 for each 100/mm3 increase in CD4 cell count) were associated with decreased risk of NCSC, whereas age (RR 2.49, 95% CI 1.12-5.92 for each l0-year increase in age) was predictive of the subsequent development of NCSC. To conclude, CD4 cell depletion is associated with the development of solid cancers and lymphoma in RTR.
Journal of the American Society of Nephrology : JASN, 2000
Renal transplant recipients have disproportionately high rates of arteriosclerotic outcomes, and ... more Renal transplant recipients have disproportionately high rates of arteriosclerotic outcomes, and recent studies provided controlled evidence that clinically stable renal transplant recipients have an excess prevalence of hyperhomocysteinemia. Few studies suggest that hyperhomocysteinemia may be a cardiovascular risk factor in renal transplant recipients. In the study presented here, the association between atherosclerotic events and homocysteine concentrations was examined in 207 stable renal transplant recipients. The role of hyperhomocysteinemia was analyzed with respect to other known cardiovascular risk factors. The mean follow-up was 21.2 +/- 1.9 mo (range, 14 to 26). Mean total homocysteine (tHcy) was 21.1 +/-9.5 micromol/L and median concentration was 19 micromol/L. Seventy percent of patients (n = 153) were hyperhomocysteinemic (values >15 micromol/L). tHcy correlated negatively with folate concentration (r = -0.3; P < 0.01). tHcy was closely related to creatinine conc...
We conducted a prospective, uncontrolled, open study to assess the relationship between homocyste... more We conducted a prospective, uncontrolled, open study to assess the relationship between homocysteine (tHcy) and oxidative stress in chronic, stable, renal transplant recipients (RTR). Included in the study were 17 chronic, stable RTR. All the patients received folic acid (5 mg/day). tHcy and total antioxidant capacity (TAOC) were measured before and at the end of the study period. Mean tHcy concentration was 26+/-10 micromol/L. tHcy significantly decreased during the study period (26+/-10 vs. 18+/-7 micromol/L; P&amp;amp;amp;amp;lt;0.001). There was a significant inverse relationship between TAOC and tHcy (r= -0.33; P=0.01). TAOC significantly increased during the study period (1.49+/-0.23-1.78+/-0.6; P&amp;amp;amp;amp;lt;0.001). There was an inverse relationship between the variation in tHcy and the variation in TAOC (r= -0.44; P=0.01). Our results demonstrate that hyperhomocysteinemia contributed to increased oxidative stress in RTR. tHcy-lowering treatment with folic acid may lower oxidative stress.
Antithymocyte globulin (ATG) preparations are frequently used as induction treatment in renal tra... more 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. 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. 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]). 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.
Background. In a recent uncontrolled retrospective report we suggested that the long-term supplem... more Background. In a recent uncontrolled retrospective report we suggested that the long-term supplementa- tion of high-dose, i.v. folinic acid combined with high- dose i.v. pyridoxine was highly effective in correcting plasma total homocysteine (tHcy) concentrations in haemodialysis patients. To confirm these findings, we conducted a randomized, controlled trial aimed at evaluating whether i.v. or oral folinic acid provided improved tHcy-lowering
Background. Hyperhomocysteinemia is an independent risk factor for the development of cardiovascu... more Background. Hyperhomocysteinemia is an independent risk factor for the development of cardiovascular conditions in chronic stable renal-transplant recipients (RTR). Major determinants of plasma total homocysteine (tHcy) in RTR are renal function and folate levels. The data dealing with the possible regulation of the tHcy metabolism by insulin and nutritional status is conflicting in non-transplant populations. Methods. We examined the relationship between tHcy, insulin and nutritional status in 103 chronic, stable RTR. Demographic, clinical, and biochemical parameters were assessed for each patient. Results. Mean tHcy was 19.7"9.2 mmolul (range 8.6–53). The tHcy was strongly related to creatinine clearance (rs0.55, P-0.0001). Fasting tHcy levels were negatively related to folate concentrations (rs 0.32, Ps0.01). There was a positive relationship between tHcy and LDL-cholesterol (rs0.34, Ps0.03) and a significant negative correlation between tHcy and insulin (rs 0.38, Ps0.01). F...
Annals of transplantation : quarterly of the Polish Transplantation Society, 2001
Cardiovascular disease (CVD) is one of the leading cause of mortality in renal transplant recipie... more Cardiovascular disease (CVD) is one of the leading cause of mortality in renal transplant recipients. Authors review accepted CVD risk factors. The role of additional factors like increased homocysteine level is discussed.
Cyclosporin withdrawal with concomitant conversion from azathioprine to mycophenolate mofetil in ... more Cyclosporin withdrawal with concomitant conversion from azathioprine to mycophenolate mofetil in renal transplant recipients with chronic allograft nephropathy: a 2-year follow-up The results presented in this paper have not been published previously in whole or part except in abstract form. This work was presented as an oral communication at the EDTA XXXVIIth congress and has received an award from the EDTA.
Hypertension is highly prevalent in the dialysis population, and has been implicated in the patho... more Hypertension is highly prevalent in the dialysis population, and has been implicated in the pathogenesis of the observed excess of cardiovascular morbidity and mortality in these patients. Nevertheless, there are no reports on the clinical and biochemical determinants of both pulse pressure (PP) and mean arterial pressure (MAP) in dialysis populations. A total of 541 haemodialysed patients from 11 dialysis centres were included in the study. The demographic, clinical, and biological characteristics were recorded. Both pre- and post- dialytic blood pressures (systolic and diastolic) were measured. PP and MAP were calculated. Mean predialytic PP was 67 +/- 17 mm Hg and significantly decreased after dialysis (60 +/- 18 mm Hg; P &lt; 0.0001). In multivariate analysis, a 10 mm Hg increase in PP was positively associated with age (RR, 2.01; 95% CI, 1.35-5.01, for a 10-year increase in age), diabetes mellitus (RR, 1.08; 95% CI, 1.04-1.14), interdialytic weight gain (IWG) (RR, 1.84; 95% CI, 1.07-3.18, for 1% increase in IWG), and current smoking (RR, 2.59; 95% CI, 1.13-5.92) and negatively with Hb concentration (RR, 0.92; 95% CI, 0.84-0.99, for a 1 g/100 ml in Hb). Mean predialytic MAP was 98 +/- 15 mm Hg and significantly decreased after dialysis (91 +/- 16 mm Hg; P &lt; 0.0001). In multivariate analysis, a 10 mm Hg increase in MAP was positively associated with parathyroid hormone (PTH) (RR, 1.32; 95% CI, 1.15-1.6, for 50 ng/ml in PTH), erythropoietin (EPO) treatment (RR, 1.09; 95% CI, 1.03-1.16), and current smoking (RR, 1.87; 95% CI, 1.39-2.41). PP and MAP are associated with different clinical parameters. Most of these factors are potentially reversible. Smoking cessation, correction of anaemia and limitation of IWG should be important challenges for physicians in care of dialysis patients.
The high incidence of cardiovascular disease in hemodialyzed (HD) patients is well established an... more The high incidence of cardiovascular disease in hemodialyzed (HD) patients is well established and oxidative stress has been involved in this phenomenon. The aim of our study was to evaluate if a vitamin E-coated dialyzer could offer protection to HD patients against oxidative stress. Sixteen HD patients were successively assessed for one month (i) on a high biocompatible synthetic dialyzer (AN) and (ii) on a vitamin E-coated dialyzer (VE). Blood samples were taken before and after the dialysis session at the end of each treatment period. HD session conducted with the AN dialyzer was responsible for acute oxidative stress, significantly assessed after HD by a decreased plasma vitamin C level and an increased ascorbyl free radical (AFR)/vitamin C ratio used as an index of oxidative stress. Plasma elastase activity, reflecting neutrophil activation, was also increased; soluble P-selectin, reflecting platelet activation, did not show any variation. The use of the VE dialyzer was associated with a less extended oxidative stress compared with the AN membrane: basal vitamin C level was higher, and after the HD session AFR/vitamin C ratio and elastase activity were not significantly increased. Plasma vitamin E levels were not affected. Our study demonstrates that HD is associated with oxidative stress, which can be partially prevented by the use of a vitamin E-coated dialyzer. Our data suggest that this dialyzer may exert a site-specific scavenging effect on free radical species in synergy with a reduced activation of neutrophils.
Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this s... more Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this study, we investigated whether lymphocyte subset count could predict the risk of developing noncutaneous neoplasia (NCSC) in renal transplant recipients (RTR). Between January 1995 and December 1995, lymphocyte subsets (CD4, CD8, CD19) were measured in 28 1 RTR. This population was studied until November 1999 for the development of NCSC. The mean follow-up was 42 k 9 months. Neoplasm was diagnosed in 22 patients (7.9%). Patients who developed a cancer were significantly older (53.8 * 6 years vs 38 & 16 years, P < O.OOOl), had lower CDq (234 f 126/mm3 vs 543 i214/pm3, P < 0.005) and CD19 (19 k 9/mm3 vs 51 * 22/mm3, P < 0.0001) levels, and
Antiphospholipid antibodies as a risk factor for atherosclerotic events in renal transplant recip... more Antiphospholipid antibodies as a risk factor for atherosclerotic events in renal transplant recipients.BackgroundEpidemiologic studies reported that antiphospholipid antibodies (APAs) were independent predictors of atherosclerotic events. We recently reported a high prevalence of APAs in renal transplant recipients. Nevertheless, the role of APAs on atherosclerotic events has not been prospectively studied in this high-risk population.MethodsParticipants in the study were 324 consecutive
Because recent large studies have demonstrated that mycophenolate mofetil (MMF) is superior to az... more Because recent large studies have demonstrated that mycophenolate mofetil (MMF) is superior to azathioprine (AZA) as a posttransplant immunosuppressant, it has been speculated that MMF could have a cyclosporin (CsA)sparing effect in renal transplant recipients with chronic allograft dysfunction. Between April 1996 and October 1998, 31 patients with chronic allograft dysfunction were assigned to have conversion from AZA to MMF with concomitant CsA withdrawal. Patient and graft outcomes were analysed. Mean follow-up time after MMF conversion was 27 * 11 months. Serum creatinine concentration (sCt) significantly decreased after conversion and remained stable at the end of followup (227 * 3 1 pmol/l vs. 185 It 50 pmol/l; P < 0.0005). Mean variation in sCt was -24% after conversion, whereas it was +20% in the year before conversion ( P < 0.001). There was a significant inverse relationship between proteinuria at baseline and improvement in renal function (r = -0.35; P = 0.01). Proteinuria increased during follow-up (0.79 It 0.6 vs.
Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this s... more Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this study, we investigated whether lymphocyte subset count could predict the risk of developing noncutaneous neoplasia (NCSC) in renal transplant recipients (RTR). Between January 1995 and December 1995, lymphocyte subsets (CD4, CD8, CD19) were measured in 28 1 RTR. This population was studied until November 1999 for the development of NCSC. The mean follow-up was 42 k 9 months. Neoplasm was diagnosed in 22 patients (7.9%). Patients who developed a cancer were significantly older (53.8 * 6 years vs 38 & 16 years, P < O.OOOl), had lower CDq (234 f 126/mm3 vs 543 i214/pm3, P < 0.005) and CD19 (19 k 9/mm3 vs 51 * 22/mm3, P < 0.0001) levels, and more frequently had past histories of skin cancer (24% vs 4%, P < 0.01). Cox regression revealed that high CD4 levels (RR 0.73, 95% CI 0.62-0.89 for each 100/mm3 increase in CD4 cell count) were associated with decreased risk of NCSC, whereas age (RR 2.49, 95% CI 1.12-5.92 for each l0-year increase in age) was predictive of the subsequent development of NCSC. To conclude, CD4 cell depletion is associated with the development of solid cancers and lymphoma in RTR.
Journal of the American Society of Nephrology : JASN, 2000
Renal transplant recipients have disproportionately high rates of arteriosclerotic outcomes, and ... more Renal transplant recipients have disproportionately high rates of arteriosclerotic outcomes, and recent studies provided controlled evidence that clinically stable renal transplant recipients have an excess prevalence of hyperhomocysteinemia. Few studies suggest that hyperhomocysteinemia may be a cardiovascular risk factor in renal transplant recipients. In the study presented here, the association between atherosclerotic events and homocysteine concentrations was examined in 207 stable renal transplant recipients. The role of hyperhomocysteinemia was analyzed with respect to other known cardiovascular risk factors. The mean follow-up was 21.2 +/- 1.9 mo (range, 14 to 26). Mean total homocysteine (tHcy) was 21.1 +/-9.5 micromol/L and median concentration was 19 micromol/L. Seventy percent of patients (n = 153) were hyperhomocysteinemic (values >15 micromol/L). tHcy correlated negatively with folate concentration (r = -0.3; P < 0.01). tHcy was closely related to creatinine conc...
We conducted a prospective, uncontrolled, open study to assess the relationship between homocyste... more We conducted a prospective, uncontrolled, open study to assess the relationship between homocysteine (tHcy) and oxidative stress in chronic, stable, renal transplant recipients (RTR). Included in the study were 17 chronic, stable RTR. All the patients received folic acid (5 mg/day). tHcy and total antioxidant capacity (TAOC) were measured before and at the end of the study period. Mean tHcy concentration was 26+/-10 micromol/L. tHcy significantly decreased during the study period (26+/-10 vs. 18+/-7 micromol/L; P&amp;amp;amp;amp;lt;0.001). There was a significant inverse relationship between TAOC and tHcy (r= -0.33; P=0.01). TAOC significantly increased during the study period (1.49+/-0.23-1.78+/-0.6; P&amp;amp;amp;amp;lt;0.001). There was an inverse relationship between the variation in tHcy and the variation in TAOC (r= -0.44; P=0.01). Our results demonstrate that hyperhomocysteinemia contributed to increased oxidative stress in RTR. tHcy-lowering treatment with folic acid may lower oxidative stress.
Antithymocyte globulin (ATG) preparations are frequently used as induction treatment in renal tra... more 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. 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. 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]). 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.
Background. In a recent uncontrolled retrospective report we suggested that the long-term supplem... more Background. In a recent uncontrolled retrospective report we suggested that the long-term supplementa- tion of high-dose, i.v. folinic acid combined with high- dose i.v. pyridoxine was highly effective in correcting plasma total homocysteine (tHcy) concentrations in haemodialysis patients. To confirm these findings, we conducted a randomized, controlled trial aimed at evaluating whether i.v. or oral folinic acid provided improved tHcy-lowering
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