Tubular epithelial cell and podocyte apoptosis with de novo sirolimus based immunosuppression in renal allograft recipients with DGF

Sirolimus is associated with prolongeddelayed graft function (DGF) following renaltransplantation and exacerbation of proteinuria. Weassessed renal allograft biopsies from DGF patientstreated with de novosirolimus (n = 10) for renal tubularcell and podocyte apoptosis and expression of activatedcaspase-3, Bcl-2, and mTOR and compared them tobiopsies from DGF patients not receiving sirolimus (n =15). Both groups received mycophenolate mofetil,prednisone and antibody induction. Apoptosis wasassessed using terminal deoxynucleodidyl transferasemediated dUTP nick end labeling (TUNEL) staining.Caspase-3, Bcl-2, and mTOR expression were assessedby immunohistochemistry. Sirolimus treated patients had334±69 TUNEL positive cells per 5 high power fieldscompared to 5.5±2.9 TUNEL positive cells in controlpatients (p<0.001). The number of TUNEL positive cellscorrelated with tubular architectural disruption.Expression of activated caspase-3, Bcl-2, or activatedmTOR did not differ between groups. 60% of biopsiesfrom sirolimus treated patients compared to 7% ofbiopsies from controls showed diffuse podocyteapoptosis (p = 0.007). There was no podocyte expressionof activated mTOR, activated caspase-3, or Bcl-2 ineither group. These data suggest that DGF patientstreated with sirolimus have increased renal tubular cellapoptosis and podocyte apoptosis

Factors affecting responsiveness to hepatitis B immunization in dialysis patients

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are widespread health problems all over the world and have high morbidity and mortality. Hemodialysis patients are more frequently exposed to these viruses as they have poor immune system and frequently undergo parenteral interventions. The vaccination against HBV prevents infection and it has been recommended for the prevention of HBV infection in all susceptible dialysis patients. This study aimed to determine the seroprevalence of HBV and HCV infections and analyzed the factors affecting inadequate response to HBV vaccine in dialysis patients