Pediatric renal transplantation under tacrolimus-based immunosuppression

Background. Tacrolimus has been used as a primary immunosuppressive agent in adult and pediatric renal transplant recipients, with reasonable outcomes. Methods. Between December 14, 1989 and December 31, 1996, 82 pediatric renal transplantations alone were performed under tacrolimus-based immunosuppression without induction anti-lymphocyte antibody therapy. Patients undergoing concomitant or prior liver and/or intestinal transplantation were not included in the analysis. The mean recipient age was 10.6±5.2 years (range: 0.7-17.9). Eighteen (22%) cases were repeat transplantations, and 6 (7%) were in patients with panel-reactive antibody levels over 40%. Thirty-four (41%) cases were with living donors, and 48 (59%) were with cadaveric donors. The mean donor age was 27.3±14.6 years (range: 0.7-50), and the mean cold ischemia time in the cadaveric cases was 26.5±8.8 hr. The mean number of HLA matches and mismatches was 2.8±1.2 and 2.9±1.3; there were five (6%) O-Ag mismatches. The mean follow-up was 4.0±0.2 years. Results. The 1- and 4-year actuarial patient survival was 99% and 94%. The 1- and 4-year actuarial graft survival was 98% and 84%. The mean serum creatinine was 1.1±0.5 mg/all, and the corresponding calculated creatinine clearance was 88±25 ml/min/1.73 m2. A total of 66% of successfully transplanted patients were withdrawn from prednisone. In children who were withdrawn from steroids, the mean standard deviation height scores (Z-score) at the time of transplantation and at 1 and 4 years were - 2.3±2.0, -1.7±1.0, and +0.36±1.5. Eighty-six percent of successfully transplanted patients were not taking anti-hypertensive medications. The incidence of acute rejection was 44%; between December 1989 and December 1993, it was 63%, and between January 1994 and December 1996, it was 23% (P=0.0003). The incidence of steroid-resistant rejection was 5%. The incidence of delayed graft function was 5%, and 2% of patients required dialysis within 1 week of transplantation. The incidence of cytomegalovirus was 13%; between December 1989 and December 1992, it was 17%, and between January 1993 and December 1996, it was 12%. The incidence of early Epstein- Barr virus-related posttransplant lymphoproliferative disorder (PTLD) was 9%; between December 1989 and December 1992, it was 17%, and between January 1993 and December 1996, it was 4%. All of the early PTLD cases were treated successfully with temporary cessation of immunosuppression and institution of antiviral therapy, without patient or graft loss. Conclusions. These data demonstrate the short- and medium-term efficacy of tacrolimus-based immunosuppression in pediatric renal transplant recipients, with reasonable patient and graft survival, routine achievement of steroid and anti- hypertensive medication withdrawal, gratifying increases in growth, and, with further experience, a decreasing incidence of both rejection and PTLD

Longitudinal Increase in Anisometropia in Older Adults

PurposeAnisometropia shows an exponential increase in prevalence with increasing age based on cross-sectional studies. The purpose of this study was to evaluate longitudinal changes in anisometropia in all refractive components in older observers and to assess the influence of early cataract development.MethodsRefractive error was assessed at two time points separated by approximately 12 years in 118 older observers (aged 67.1 and 79.3 years at the two test times). Anisometropia defined as greater than or equal to 1.00 D was calculated for all refractive components. The subjects had intact ocular lenses in both eyes throughout the study. Lens evaluations were performed at the second test using the Lens Opacities Classification System III.ResultsAll refractive components approximately doubled in prevalence of anisometropia. Spherical equivalent anisometropia changed from 16.1 to 32.2%. Similar changes were found for spherical error (17 to 38.1%), primary astigmatism (7.6 to 17.8%), and oblique astigmatism (14.4 to 29.7%). Many who did not have anisometropia at the first visit subsequently developed anisometropia (e.g., 26.3% for spherical error and 22.9% for oblique cylinder). The onset of anisometropia occurred at all ages within the studied age range, with no particular preference for any one age. A small number lost anisometropia over time. Individual comparisons of refractive error changes in the two eyes in combination with nuclear lens changes showed that early changes in nuclear sclerosis in the two eyes could account for a large proportion of anisometropia (~40%), but unequal hyperopic shift in the spherical component in the two eyes was the primary cause of the anisometropia.ConclusionsAnisometropia is at least 10 times more common in the elderly than in children, and anisometropia develops in all refractive components in the oldest observers. Clinicians need to be aware of this common condition that could lead to binocular vision problems and potentially cause falls in the elderly

Alcohol’s Effects During Uncertain and Uncontrollable Stressors in the Laboratory

Alcohol’s effects on reactivity to stressors depend on the nature of the stressor and the reactivity being assessed. Research that identifies characteristics of stressors that modulate reactivity and clarifies the neurobehavioral, cognitive, and affective components of this reactivity may help prevent, reduce, or treat the negative impacts of acute and chronic alcohol use and have implications for other psychopathology involving maladaptive reactivity to stressors. We used a novel, multimeasure, cued, electric-shock-stressor paradigm in a greater-university community sample of adult recreational drinkers to test the effects of alcohol ( n = 64), compared with no alcohol ( n = 64), on reactivity to stressors that vary in both their perceived certainty and controllability. Preregistered analyses suggested alcohol significantly dampened subjective anxiety (self-report) and defensive reactivity (startle potentiation) more during uncertain stressors than during certain stressors regardless of controllability, which suggests that stressor uncertainty—but not uncontrollability—may be sufficient to enhance alcohol’s dampening of stress reactivity and thus negative reinforcement potential

Preprint: Alcohol's effects during uncertain and uncontrollable stressors in the laboratory

Alcohol’s effects on reactivity to stressors depend on the nature of the stressor and the reactivity being assessed. Research identifying characteristics of stressors that modulate reactivity and clarifies the neurobehavioral, cognitive, and affective components of this reactivity may help prevent, reduce or treat the negative impacts of acute and chronic alcohol use with implications for other psychopathology involving maladaptive reactivity to stressors. We used a novel, multi-measure, cued electric shock stressor paradigm in a greater university community sample of adult recreational drinkers to test how alcohol (N=64), compared to No-alcohol (N=64), affects reactivity to stressors that vary in both their perceived certainty and controllability. Preregistered analyses suggested alcohol significantly dampened subjective anxiety (self-report) and defensive reactivity (startle potentiation) more during uncertain than during certain stressors regardless of controllability, suggesting that stressor uncertainty —but not uncontrollability— may be sufficient to enhance alcohol’s stress reactivity dampening and thus negative reinforcement potential