CME on Transplantation is dedicated to online CME conferences, courses and presentations (slides with voice over) on transplantation, given by local and international experts. Its mission is to keep you up-to-date with the most recent developments on transplantation.
Summary : Atherosclerosis is the leading cause of morbidity and mortality in renal transplant patients. More than half of kidney transplant losses are due to the death of the patient with the continued function of the graft (death-censored graft loss) and almost half of these losses are due to vascular events.
In this presentation, Dr. Hayry examines the rationale behind the development of new Vasculoprotective medications. He begins by establishing the need for new therapies and subsequently discusses the pathogenesis of atheromatous plaques, particularly the origin of neo-intimal “smooth muscle cell-like” cells.
The relative merits and short-comings of rodent versus non-human primate models of athermoatous disease are discussed. Dr. Hayry then examines a number of studies pertaining to the newer vasculoprotective drugs, including selective somatostatins, sirolimus and imanitib.
Learning objectives : After viewing this presentation, participants will be able to discuss the:
- Epidemiology and etiology of renal graft loss.
- Predictive value of CADI for predicting renal graft loss.
- Origin of neo-intimal SMC-like cells.
- Relative merits and short-comings of both rodent and primate models of atherosclerosis.
- Distribution and role of somatostatin receptor families.
- Effect of sirolimus in combination with either imanitib or cyclosporine.
Du Toit D, Aavik E, Taskinen E, Myburgh E, Aaltola E, Aimonen M, Aavik S, van Wyk J, Hayry P. Structure of carotid artery in baboon and rat and differences in their response to endothelial denudation angioplasty. Ann Med. 2001 Feb;33(1):63-78.
Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, Colombo A, Schuler G, Barragan P, Guagliumi G, Molnar F, Falotico R; RAVEL Study Group. Randomized Study with the Sirolimus-Coated Bx Velocity Balloon-Expandable Stent in the Treatment of Patients with de Novo Native Coronary Artery Lesions. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002 Jun 6;346(23):1773-80.
Summary : This presentation will look at clinical outcomes of kidney transplantation and the factors affecting long-term survival. It has been shown that kidney transplant survival has improved in recent years (1), and the possible reasons for this can be manifold. For example, this improvement could be due to immunological factors, better medical management of the patient, and more aggressive diagnostic and biopsy procedures. There may also still be unknown factors that affect long-term survival.
Post-transplant renal function has recently been studied and serum creatinine values were found to be predictive of long-term graft survival in a large cohort of kidney transplant recipients (2). It was also found that renal function has improved in recent years (2). The transplant era has reduced acute rejection and improved renal function, and these factors both affect long-term survival. Immunosuppression has also evolved in recent years to produce new agents, which improve renal function (3).
Learning objectives : The participant will learn about clinical outcomes in kidney transplantation, looking at various factors affecting long-term survival.
Long-term Survival – Conclusion:
Improved
- Era
- Acute Rejection
- Renal Function
- Immunosuppressants
