Papers by nabil M . A F hassan
The American Journal of Tropical Medicine and Hygiene, 2001
Schistosomiasis is a widespread helminthic disease. Treatment of schistosomiasis is based on chem... more Schistosomiasis is a widespread helminthic disease. Treatment of schistosomiasis is based on chemotherapy with praziquantel, which is the drug of choice. Since resistance to praziquantel has been demonstrated, alternative drugs must be considered. Myrrh is an oleo-gum resin from the stem of the plant Commiphora molmol. This study was carried out on 204 patients with schistosomiasis. The drug was given at a dose of 10 mg/kg of body weight/day for three days, and induced a cure rate of 91.7%. Re-treatment of cases who did not respond with a dose of 10 mg/kg of body weight/day for six days gave a cure rate of 76.5%, increasing the overall cure rate to 98.09%. The drug was well tolerated, and side effects were mild and transient. Twenty cases provided biopsy specimens six months after treatment and none of them showed living ova.
American Journal of Nephrology, 2003
Background/Aim: Transforming growth factor-β1 (TGF-β1) is involved in the pathogenesis of chronic... more Background/Aim: Transforming growth factor-β1 (TGF-β1) is involved in the pathogenesis of chronic allograft nephropathy after kidney transplantation. The aim of the study was to evaluate the effect of the angiotensin receptor blocker losartan on TGF-β1 plasma levels and proteinuria in hypertensive transplant recipients. Methods: A total of 162 transplant recipients were included in the study. The patients were randomized into 3 groups: group 1 received losartan; group II received an angiotensin-converting enzyme inhibitor (captopril), and group III received a calcium channel blocker (amlodipine). All the parameters were recorded at the time of therapy initiation and at 1, 4 and 12 weeks and 12 months thereafter. Graft biopsy before the start and at the end of the study was done to evaluate histopathological progression. Results: Blood pressure was controlled in the 3 groups; however, the need for other antihypertensive agents was significant in groups I and II. Treatment with losart...
– African Journal of Nephrology, 2009
We analyzed the incidence of vascular complications in adults and pediatrics live donor renal tra... more We analyzed the incidence of vascular complications in adults and pediatrics live donor renal transplantations over 3-decades and compared its impact upon patient and graft survival in both groups.
Arab Journal of Urology, 2011
We aimed to analyse donor and recipient predictors of graft survival in children who received liv... more We aimed to analyse donor and recipient predictors of graft survival in children who received live-donor renal grafts. Patients and methods: The study comprised 273 children who received live-donor renal transplants at our center between March 1976 and October 2010. The follow-up ranged from 6 months to 25 years. Donor variables included donor age, gender, donor/recipient body weight ratio (DR BWR), ABO blood groups, human leukocyte antigen, and DR mismatching. Donor-specific problems, e.g., ischemia time during surgery and number of renal arteries, were included. Recipient variables included recipient age, sex, original kidney disease, ischemia time, acute tubular necrosis (ATN) after transplantation, immunosuppression, number of acute rejection episodes, re-transplantation, and development of hypertension. Results: Independent variables with a sustained effect on the 5-and 10-year graft survival on multivariate analysis were: ATN after transplant, number of acute rejections, hypertension, and DR BWR. At the last follow-up, 185 patients (67.8%) had a functioning graft, while 82 (30.0%) had graft failure. Only six patients (0.02%) were lost to follow-up. Conclusion: Donor and recipient variables that affect short-and long-term graft survival in children with a live-donor renal allograft are DR BWR, number of acute rejections, ATN and hypertension after transplant. Considering these variables provides a better outcome.
Experimental and Clinical Transplantation, 2012
Objectives: Acute rejection in renal transplant is considered a risk factor for short-term and lo... more Objectives: Acute rejection in renal transplant is considered a risk factor for short-term and long-term allograft survival. The expected reversal rate for the first acute cellular rejection, by steroid pulse, ranges between 60% and 100%, and lack of improvement within 1 week of treatment is defined as steroidresistant rejection. This work sought to evaluate factors that lead to steroid-resistant acute cellular rejection among patients with first live-donor renal allotransplant and its effect on graft and patient survival. Materials and Methods: Patients with an improvement in serum creatinine levels were considered controls (group 1; n=100); while the others were considered an early steroid-resistant group (group 2; n=99). Both groups were matched demographically. Results: Patients with a target cyclosporine level below accepted therapeutic levels were significantly higher in group 2 (P = .02). We found no significant differences between the groups regarding posttransplant complications (P > .05). Mean hospital stay was longer in group 2 (P = .021). Living patients with functioning graft were more prevalent in group 1, while those alive on dialysis were more prevalent in group 2. The groups were comparable regarding long-term patient and graft survival despite significantly lower creatinine values in patients of group 1 at 6 months' follow-up (P ≤ .001). Conclusions: Prebiopsy low cyclosporine trough levels and associated chronic changes among patients who were maintained on calcineurin inhibitor-based regimens represented the most-important risk factors for the early steroid-resistant group. Rescue therapies improve short-term graft outcome; however, they did not affect either patient or long-term graft survival after 5 years' follow-up.
Diálisis y Trasplante, 2012
Background: Identification of problems associated with kidney transplantation in small weight chi... more Background: Identification of problems associated with kidney transplantation in small weight children is an essential step toward improving graft function and patient survival. Methods: This study comprised 63 renal transplant children weighing 25 kg or less at time of renal transplantation. All children have received living-donor renal allotransplant between December 1984 and March 2009. These children were retrospectively evaluated regarding their survival, grafts survival as well as associated risk factors. Results: Our patient and graft survival rates at 1, 5 and 10 years were (98.4%, 96.8%, and 96.8%) and (94.9%, 82.6%, and 58.4%), respectively. Significant better graft survival was obtained in cases with non-glomerular etiology of the end-stage renal disease, pre-emptive transplantation and when the aorta was used for arterial vascular anastomosis. Significant worse graft survival was documented among those who experienced pre-transplant hypertension, pre-transplant blood transfusion, post-transplant acute rejection, chronic rejection, hypertension and graft obstruction. Conclusion: The outcome of live donor renal transplantation in children weighing 15-25 kg in our locality as a developing country is comparable to other reports. Better graft survival rates might be obtained by adopting pre-emptive transplant policy, avoiding pre-transplant blood transfusions, using aorta for arterial vascular anastomosis in addition to adopting recent tacrolimus-based immunosuppressive regimens that is associated with reduced incidence of post-transplant acute rejection and graft dysfunction.
Nephrology Dialysis Transplantation, 2004
Background. The deliberate use of ketoconazole to reduce the need for cyclosporine (CsA) is not n... more Background. The deliberate use of ketoconazole to reduce the need for cyclosporine (CsA) is not new, but it is particularly relevant because of the high cost of CsA. Many studies have documented this benefit in renal and cardiac transplants, but this coadministration has not been reported in patients with nephrotic syndrome. Methods. This retrospective study included 207 nephrotic patients who were steroid resistant, dependent or frequent relapsers and received CsA therapy. Among these patients 153 received daily ketoconazole therapy in a dose of 50 mg with concomitant decrease of one-third of the CsA dose while 54 patients received CsA alone. The majority of our cases were children (179 were below 18 years) and male to female ratio was 1.7:1. Results. The great majority of the study population received the drugs for 1-2 years. Patients who received CsA and ketoconazole were comparable with those who received CsA alone regarding age, sex, duration of renal disease, renal pathology, severity of nephrotic syndrome, renal function, hepatic function and steroid response. Co-administration of ketoconazole significantly reduced mean doses of CsA by 37% after 1 month and 47% at 1 year with overall net cost savings of 37%. Hepatic functions remained within the normal range in both groups. Additionally, co-administration of ketoconazole significantly improved the response to CsA therapy, successful steroid withdrawal and decreased the frequency of renal impairment. Conclusions. Co-administration of keto with CsA in idiopathic nephrotic patients significantly reduces CsA costs and may improve its response.
American Journal of Nephrology, 2003
Background/Aims: Despite the high rate of rejection, allograft failure and patient mortality in t... more Background/Aims: Despite the high rate of rejection, allograft failure and patient mortality in the early years of renal allotransplantation, some patients have done-remarkably well. We report here on 62 renal transplant recipients out of 144 patients (43%) who had functioning grafts for more than 15 years (range 15–24 years). Materials: Demographic and follow-up data for patients fulfilling the criteria were reviewed. These patients include 43 males and 19 females, with a mean age at transplantation of 27.5 ± 6.6 years (range 9–43 years), and mean donor age of 30 ± 8.6 years. The donor source was 8 parents, 49 siblings and 5 unrelated. The main causes of end-stage renal disease were chronic pyelonephritis and chronic glomerulonephritis. Twenty-nine patients were treated with cyclosporine (CsA) while 33 patients were primarily immunosuppressed by steroids and azathioprine. Results: Acute rejection episodes occurred in 40 patients (64.3%), out of them 19 patients experienced two or m...
American Journal of Nephrology, 2003
Background/Aims: There have been conflicting reports showing that kidneys from small donors may b... more Background/Aims: There have been conflicting reports showing that kidneys from small donors may be at risk for graft loss if they are transplanted into large recipients. The aim of this work was to examine the donor/recipient body weight ratio (D/RBWR) on patient and graft outcome. Methods: During the period from January 1990 to January 2002, 856 kidney transplants were performed. Of these, 776 kidney transplant recipients were selected after exclusion of pediatric, second transplant patients and those with a body mass index of ≧35. All patients achieved a minimum follow-up of 1-year. According to D/RBWR, patients were divided into 3 groups: low (≤0.9), medium (0.91–1.2) and high (≧1.2). Data were collected on graft function, acute and chronic rejection, post-transplant complications, and 1- and 5-year graft and patient survival. Results: There was a statistically significant increase in the incidence of chronic rejection, post-transplant hypertension and diabetes mellitus in the lo...
Nephrology Dialysis Transplantation, 2005
Background. Because of its potential nephrotoxicity, the long-term use of cyclosporine (CsA) as t... more Background. Because of its potential nephrotoxicity, the long-term use of cyclosporine (CsA) as treatment for nephrotic syndrome (NS) is controversial. The clinical outcome of the patients with NS treated with CsA is unclear. Methods. This study reports the results of long-term CsA treatment in 117 children with idiopathic NS, who received CsA therapy for more than 2 years (median, 34 months). The mean age of children at initiation of CsA therapy was 11±4 years. The starting dose of CsA was 5 mg/kg/day, adjusted to maintain a trough level of 100-150 ng/ml in the first 2 months, 50-100 ng/ml thereafter. Later, a level as low as 30 ng/ml was accepted so long as it maintained remission. All patients received CsA between 1993 and 2003. Indications for treatment included steroiddependent nephrotic syndrome (SDNS) in 74 patients and steroid-resistant nephrotic syndrome (SRNS) in 43 patients. Initial renal histology showed minimal change disease (MCD) in 38 patients and focal segmental glomerulosclerosis (FSGS) in 79 patients. Most patients were receiving moderate doses of prednisone. Sixty patients received cyclophosphamide prior to CsA. The observation periods were 5.8±3 years and 6.1±1.9 years before and after CsA treatment, respectively. Results. Complete remission [proteinuria <4 mg/h/m 2 / body surface area (BSA)], partial remission (proteinuria between 4.1 and 40 mg/h/m 2 /BSA) and resistance to CsA (proteinuria 45 mg/h/m 2 /BSA) were observed in 82.1, 5.1 and 12.8%, respectively. Hypertension, renal impairment (>30% rise of serum creatinine), gingival hyperplasia and hypertrichosis occurred in 10.3, 6.0, 32.5 and 70.1%, respectively. Steroids were stopped in 102 patients, of which 31 relapsed. Out of 29 patients for whom CsA was intentionally discontinued while in remission, 22 relapsed. Of these, six patients were resistant to a second course of CsA. Post-therapy biopsies, performed in 45 patients (33 with SDNS and 12 with SRNS), showed mild stripped interstitial fibrosis and tubular atrophy in two SDNS patients (4.4%). At the last follow-up, one child had developed end-stage renal failure and two had chronic renal insufficiency. Conclusions. Long-term CsA therapy in low doses is effective in the treatment of children with idiopathic NS, but the rate of relapse is high after drug withdrawal. Hypertension developed in 10% of patients and renal insufficiency in 6% (most patients with FSGS).
– African Journal of Nephrology, 2009
Introduction: Post-transplantation anemia (PTA) occurs frequently, with prevalence rates between ... more Introduction: Post-transplantation anemia (PTA) occurs frequently, with prevalence rates between 20 and 60% depending on the criteria used for defining anemia. Aim of the work: We aimed to assess the prevalence of anemia after 6 months of transplantation in pediatric renal transplant patients under different protocols of immunosuppression, and to determine the impact of anemia upon long-term patient and graft survival. Patients and methods: Based on the data of 108 renal transplants performed in our center, patients were categorized after 6 months according to their hemoglobin (Hb) levels into two groups. The first group with Hb more than 11gm/dl (group I, 29 cases) and the second group with Hb less than11gm/dl (group II, 79cases). We compared the two groups regarding post transplant complications (rejection episodes, hypertension, diabetes mellitus, infections, hepatic dysfunction, and patient and graft survival. Results: we found no significant difference between the two groups regarding rejection episodes. However, the percentage of cases with chronic allograft nephropathy was significantly higher in the
Nephrology Dialysis Transplantation, 2005
Background. Although remission is achieved in most children with nephrotic syndrome by treatment ... more Background. Although remission is achieved in most children with nephrotic syndrome by treatment with corticosteroids, a significant proportion of patients experience relapses. Continuous or repeated use of corticosteroids inevitably induces features of steroid side-effects. Cyclosporin (CsA) has been used in the treatment of idiopathic steroid-dependent and-resistant nephrotic syndrome. However, relapse often occurs shortly after the CsA treatment is terminated. Furthermore, long-term clinical outcome of patients treated with CsA is unclear. Methods. We retrospectively reviewed the data of 106 nephrotic children having primary focal segmental glomerulosclerosis (FSGS) who received CsA between 1993 and 2002. Indications of CsA therapy were steroid resistance (n ¼ 45) and steroid dependence with steroid toxicity (n ¼ 61). Fifty-four patients received cyclophosphamide prior to CsA therapy. CsA starting dose was 6 mg/kg/day to be readjusted to maintain a whole blood trough level of 80-150 ng/ml. The drug was received for 6-48 months (mean: 22.1±11 months). The observation period was 5.8±3 and 6.1± 1.9 years before and after CsA treatment, respectively. Results. Complete remission [proteinuria <4 mg/h/m 2 body surface area (BSA)], partial remission (proteinuria 4.1-40 mg/h/m 2 BSA) and resistance to CsA (proteinuria 45 mg/h/m 2 BSA) were observed in 71.7, 7.5 and 20.8% of patients, respectively. CsA-sensitive and-resistant patients differed only in the percentage of steroid responsiveness, being 66.7% in the former group and 22.7% in the later (P<0.0001). Logistic regression analysis identified steroid resistance as the only predictor of resistance to CsA (odds ratio: 12.9; P ¼ 0.03). Hypertension, renal impairment (>30% rise of serum creatinine), gingival hyperplasia and hypertrichosis occurred in 12.3, 6.6, 22.6 and 51.9% of patients, respectively. With the exception of hypertrichosis, side effects were significantly more frequent among CsA-resistant children. We were able to stop steroids in 91 patients, of whom 31 patients relapsed. Out of 20 patients for whom CsA was intentionally discontinued while in remission, 16 patients relapsed. Of these, four (25%) were resistant to a second course of CsA. At the last follow-up, one child had developed end-stage renal failure and three had chronic renal insufficiency. Conclusions. CsA is effective in the treatment of children with idiopathic FSGS, but with a high relapse rate on drug withdrawal. Renal dysfunction and hypertension, which may be drug-induced or natural progression, are the most serious complications; therefore, close monitoring is essential.
The value of intravenous immunoglobulin and simvastatin as potential modalities for the treatment... more The value of intravenous immunoglobulin and simvastatin as potential modalities for the treatment of sensitized patients was studied. We aimed to test their efficacy as solo agents to inhibit anti-human leukocyte antigen (HLA) antibodies. We tested samples from 11 adult hemodialysis patients who were waiting for renal allotransplantation at our center, all of whom had persistently positive crossmatches with their living related donors and panel reactive antibody titers more than 20%. All patients received intravenous immunoglobulin (500 mg/kg/day on alternate days for 6 doses). Panel reactive antibody titer measurement and crossmatch testing were carried out after each dose and before each subsequent one. Two months later, 8 patients received simvastatin (20 mg/day) for 2 months. Panel reactive antibody measurement titer and crossmatch testing were carried out every 2 weeks. Only 4 patients showed an insignificant reduction in panel reactive antibody activity (P = 0.36). None of them attained a negative crossmatch. Furthermore, simvastatin also resulted in an insignificant reduction of HLA antibodies in 3 patients (P = 0.32). We concluded that intravenous immunoglobulin or simvastatin alone cannot effectively inhibit preformed anti-HLA antibodies to allow successful renal transplantation. Further trials of the use of intravenous immunoglobulin and simvastatin with other modalities to desensitize these patients may be warranted.
Clinical and Experimental Nephrology, 2009
Posttransplantation anemia (PTA) frequently occurs. We aimed to assess the prevalence of anemia a... more Posttransplantation anemia (PTA) frequently occurs. We aimed to assess the prevalence of anemia at 6 months of transplantation in patients under different protocols of immunosuppression, and to determine the impact of anemia on long-term patient and graft survival. We included 832 renal transplant recipients who were categorized at 6 months according to hemoglobin (Hb) level into two groups: the first group, with Hb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;13 g/dl in males and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;12 g/dl in females (group I, 385 cases); and the second group, with Hb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;13 g/dl in males and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;12 g/dl in females (group II, 447 cases). We compared the two groups regarding posttransplant complications as well as patient and graft survival. Although there was no significant difference between the two groups regarding acute rejection episodes, chronic allograft nephropathy was significantly higher in the anemic group. Other posttransplant medical complications were comparable in both groups. Graft survival was significantly higher in the nonanemic group. However, no difference in patient survival was detected. From this study, we can conclude that prevalence of PTA is high, especially in females and those receiving calcineurine inhibitors (CNI) and mycophenolate mofetil (MMF), and that it was associated with poorer graft outcome but with no effect on patient survival.
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Papers by nabil M . A F hassan