Surveillance biopsies in children post-kidney transplant

Surveillance biopsies are increasingly used in the post-transplant monitoring of pediatric renal allograft recipients. The main justification for this procedure is to diagnose early and presumably modifiable acute and chronic renal allograft injury. Pediatric recipients are theoretically at increased risk for subclinical renal allograft injury due to their relatively large adult-sized kidneys and their higher degree of immunological responsiveness. The safety profile of this procedure has been well investigated. Patient morbidity is low, with macroscopic hematuria being the most common adverse event. No patient deaths have been attributed to this procedure. Longitudinal surveillance biopsy studies have revealed a substantial burden of subclinical immunological and non-immunological injury, including acute cellular rejection, interstitial fibrosis and tubular atrophy, microvascular lesions and transplant glomerulopathy. The main impediment to the implementation of surveillance biopsies as the standard of care is the lack of demonstrable benefit of early histological detection on long-term outcome. The considerable debate surrounding this issue highlights the need for multicenter, prospective, and randomized studies

Cyclosporine-A Induced Gingival Overgrowth

Abstract Background. The link between the gingival overgrowth and cyclosporine pharmacokinetical variables, especially cyclosporine doses which appear to act as stimulator of the gingival proliferative changes, presents a field of interest of large number of researches. The existence of undefined association and/or interaction between the cyclosporine and periodontal variables, could be responsible for this type of gingival overgrowth. The aim of this study was to examine the correlation between the degree of gingival overgrowth, daily doses of cyclosporine A and parodontal parameters. Methods. 120 patients with renal transplants were included in this examination. The cohort was divided into a four groups according to the daily dose of cyclosporine (100, 125, 150, 175 mg). The degree of gingival overgrowth (GOI) was investigated, using a MacGaw index. The plaque index (PI), apical migration, total daily doses of cyclosporine and plasma concentration, was recorded for various groups and a prospective longitudinal follow -up was conducted. Results. Statistically significant correlation was found between GOI and cyclosporine dose ( =0,3; p< 0,01) and also with dental plaque ( = 0,6; p<0,01), gingival inflammation ( =0,3; p<0,01) and lost attachment ( = 0,1; p<0,05). The lost attachment varied significantly between groups, (p<0,05). Gingival inflammation index (GII) also differed among groups with different dose (p<0,01). Our findings showed differences in gingival overgrowth index between groups (p< 0,05). Conclusions. Our results show a positive correlation between gingival overgrowth and pharmacological parameters, especially the high doses (above 175 mg) of cyclosporine and also with parodontal parameters which lead to parodontal destructions. Additionally, we underlined the effect of local factors as a cofactor in the development of this side effect