Research Data
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/20690
All the data below is licensed under unique access conditions and constraints
News
It not new but its important to note that the NRF demands open access
http://www.nrf.ac.za/media-room/news/statement-open-access-research-publications-national-research-foundation-nrf-funded
Browse
3 results
Search Results
Item Outcomes of cadaveric renal transplantation in patients using mycophenolate mofetil or azathioprine(2016-10-12) Gathara, LindaIntroduction: Mycophenolate Mofetil (MMF) has replaced Azathioprine (AZA) in immunosuppressive regimens worldwide in the prevention of acute allograft rejection. Whether long term treatment with MMF is superior to treatment with AZA is a matter of debate. There are no studies in South Africa that have been done to show that MMF is superior to AZA. Objectives: To describe the outcomes of cadaveric renal transplantation in patients using Mycophenolate Mofetil or Azathioprine over a five year period at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Design: This was a retrospective comparative study. Setting: The CMJAH Renal Transplant Unit in Johannesburg, Republic of South Africa. Patients: A convenience sample of all eligible patients, 208 in total, was recruited from the Renal Transplant Unit at CMJAH. Methods: The study was approved by the University of the Witwatersrand Human Research Ethics Committee (Medical) (Protocol Number: M130434). The data source was clinical records of renal transplant recipients at the Renal Transplant Unit at CMJAH from 1985-2013, who were treated with one of the two immunosuppressive agents required for analysis in the study. The data were entered in Microsoft Excel Spreadsheets and transferred to STATA version 14 for statistical analysis. Results: Of the 208 patients, 101 patients were treated with Azathioprine and 107 patients treated with Mycophenolate Mofetil, in addition to corticosteroids and cyclosporine. A total of 16 patients developed acute allograft rejection 12-52 weeks after cadaveric transplantation. Of these, 6% were in the AZA group and 10 % in the MMF group. There was a mortality rate of 1% in the MMF and 16.8% in the AZA group respectively (p= 0.0001). The serum creatinine at 3 months was found to be a strong predictor of allograft function in patients on Mycophenolate Mofetil (p<0.001). After adjusting for the confounders, serum creatinine at 3 months remained a strong predictor of outcome. Patients experiencing abdominal pain while on treatment with Mycophenolate Mofetil were 62% less likely to develop acute allograft rejection than patients on treatment with Azathioprine [unadjusted HR = 0.38(0.14-1.05)]. This finding however, is not statistically significant (p=0.06). After adjusting for the other confounders the association with abdominal pain was marginally significant (adjusted HR 0.18(0.01-1.02) p=0.05). Conclusions: Patient survival was superior in the longterm in cadaveric renal transplant patients receiving Mycophenolate Mofetil therapy.Item Cardiovascular risk profile of kidney transplant recipients at the Charlotte Maxeke Johannesburg Academic Hospital.(2014-04-25) Muhammad, Aminu SakajikiINTRODUCTION Cardiovascular diseases (CVD) are more common in kidney transplant recipients (KTRs) than in the general population. The high incidence of CVD in the KTRs can be attributed to traditional risk factors, additional risk factors associated with graft dysfunction and those specifically related to transplantation. Carotid intima-media thickness (cIMT) is a proven surrogate of atherosclerosis; it correlates with vessel pathology and is precisely imaged using ultrasound technology. This study was aimed at determining the prevalence and predictors of cardiovascular risk among KTRs at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to examine the relationship between cardiovascular risk factors and carotid intima media thickness. METHODS Patients aged 18 years and above who received a kidney transplant at the CMJAH between January 2005 and December 2009 were recruited. A questionnaire that captured cardiovascular risk factors was administered. Patients records were assessed for information on their post transplant follow up. All patients had echocardiography and carotid doppler done for measurement of intima-media thickness. The Framingham Risk Score was used to categorize patients into low, moderate, high risk and very high risk groups. Results were analyzed using statistical package for social sciences (SPSS) version 17, p value of 0.05 was considered significant. RESULTS One hundred (KTRs) 63 male (63%) and 37 female (37%) were recruited ranging in age from 19 to 70 years, with a mean age of 42.2 ± 12.42. Thirty six patients (36%) were found to have high cardiovascular risk. Multiple regression showed proteinuria (p = 0.022), higher cumulative steroid dosage (p = 0.028), elevated serum triglycerides (p = 0.04) and the presence of plaques in the carotid artery (p = 0.012) as predictors of higher cardiovascular risk.Carotid intima-media thickness correlates with higher CVD risk. Fourteen patients (14%) had a carotid artery plaque. Twenty five patients (25%) had cIMT of >0.7 mm. CONCLUSION Kidney transplant recipients in CMJAH were found to have high cardiovascular risk (36%) and carotid intima-media thickness correlates with this high CVD risk. Routine follow up of KTRs should include measurement of cIMT as it provides a simple non-invasive assessment of subclinical atherosclerosis.Item Establishment of a flow cytometric assay in the setting of renal transplant for T and B cell crossmatching(2014-02-17) Ramparsad, NarishaDonor specific crossmatching is performed prior to renal transplantation in order to determine the presence of pre-existing antibodies against donor HLA antigens which can result in hyperacute rejection. Flow cytometric crossmatching is reported in the literature to be a more sensitive and objective method of testing than the complement dependent cytotoxicity (CDC) method that is currently used in the Gauteng Province. A prospective analysis of the flow cytomeric crossmatch (FCXM) assay using the Luminex technology as the reference method was conducted. Forty-three samples were analysed. The T cell crossmatch (using a cutoff value of 2) revealed a sensitivity of 66.7%, a specificity of 83.8%, a positive predictive value (PPV) of 40% and negative predictive value (NPV) of 93.9%. The B cell crossmatch (using a cutoff value of 5) gave a sensitivity of 100%, specificity of 92.7%, and a PPV and NPV of 40 and100%, respectively. In addition, a retrospective analysis of clinical data for all patients transplanted during the period January 2008 to May 2009 was performed. Of a total of 50 patients assessed post transplant, none of the patients showed signs of hyperacute rejection, while twelve percent (12%) of patients revealed signs and symptoms suggestive of acute rejection. The validation of the flow cytometric crossmatch analysis was complex as there is no gold standard reference method. The assay was validated based on the clinical relevance of its high negative predictive value and the absence of hyperacute rejections in the clinical follow up. The rate of acute rejection found in this study is similar to that reported in literature.