Platelet-rich Plasma use for facial rejuvenation: a clinical trial and review of current literature

Background and aim of the work:

Several studies have shown beneficial effects for Platelet-rich plasma (PRP). We aimed to assess the efficacy of pure PRP injection for facial rejuvenation in Iran.

Methods:

30 female consecutive participants were injected with PRP in two sessions with 3 month interval. Evaluations were performed by comparing the pre- and post-improvement measurements of skin scan, before after photography by participants, therapeutic physician and blindly by a second dermatologist.

Results:

In 3 and 6 months follow-ups respectively, moderate to excellent improvement in periorbital dark circles (47.8,60.9%), periorbital wrinkles (73.9%,78.3%), nasolabial fold (52.2%,56.6%) and skin rigidity (52.3%,60.9%) reported by patients, was statistically significant only for dark circle(P value 0.031). Moderate to good improvement in periorbital dark circles (47.9%,74%), periorbital wrinkles (39.1%,43.5%)and nasolabial folds (4.3% ,13.1%) demonstrated by therapeutic physician‘s evaluation, was statistically significant for dark circle (P value 0.008) and nasolabial folds (P value 0.025). Moderate to good improvement in periorbital dark circles (34.8%, 52.2%), periorbital wrinkles (26.1%, 34.8%) and nasolabial folds (4.4%, 13%) by second dermatologist, was statistically significant for dark circle (P value 0.025).

Conclusion:

Face rejuvenation with PRP is a promising and noninvasive technique with best results observed in improving periorbital dark circles and wrinkles. (www.actabiomedica.it)

Study of the in vitro and in vivo antileishmanial activities of nimodipine in susceptible BALB/c mice

BACKGROUND & OBJECTIVES

Pentavalent antimonials are the standard treatment for cutaneous leishmaniasis (CL), however, treatment failures are frequent. Nimodipine, a calcium channel blocker is known to show promising antiprotozoal effects. Here, we investigated the antileishmanial effect of Nimodipine in both in vitro and in vivo BALB/c mice model of CL. We also compared the in vivo effect with amphotericin B and meglumine antimoniate in the experimental CL mice model.

METHODS

Colorimetric alamar blue assay and J774 A.1 mouse macrophage cells were used to determine the effect of nimodipine on promastigotes and amastigotes viability, respectively. Then, the in vivo activity of nimodipine was compared to that of conventional therapies in both the early and established courses of Leishmania major infection in susceptible non-healing BALB/c mice.

RESULTS

Nimodipine was highly active against promastigotes and amastigotes of L. major with IC₅₀ values of 49.40 and 15.03 μM, respectively. In the early model, the combination therapy with meglumine antimoniate and nimodipine showed no parasites in the spleen or footpad of animals. The footpad thickness was significantly lower in mice treated with either nimodipine (1 mg/kg or 2.5 mg/kg) or amphotericin B compared to the control group in the established lesions model. However, no complete remission was observed in the footpad lesion of any of the treatment groups (nimodipine, amphotericin B, meglumine antimoniate, and combination therapy).

INTERPRETATION & CONCLUSION

The effect of nimodipine was comparable to that of amphotericin B and meglumine antimoniate in early and established CL lesion models. Since nimodipine is more cost-effective than conventional therapies, our results merit further investigation in other animal models and voluntary human subjects.

The effect of platelet-rich plasma injection in the treatment of androgenetic alopecia

BACKGROUND

Androgenetic alopecia is the most common type of hair loss in men, which is manifested by a progressive terminal hair loss in specific areas of scalp. Platelet-rich plasma (PRP) is among treatment options for androgenetic alopecia. PRP is a human platelet concentrate in a small volume of plasma containing certain cytokines.

AIM

The aim of this study was to evaluate the efficacy and safety of autologous PRP in treatment of male androgenetic alopecia.

METHODS

This was a clinical trial in 19 patients with grade III vertex to grade V androgenetic alopecia referring to the Clinic of Ghaem Hospital between March 2015 and March 2016. All obtained liquid PRP (5 cc) was injected at around 125 points (equals to 125 cm² ) into the scalp, and operation was repeated in three sessions at 0, 4, and 8 weeks. We took macroscopic and dermoscopic pictures of each patient in 0, 4, and 8 weeks and 3 months after the last injection session. A dermatologist evaluated the treatment response using dermoscopy photos.

RESULT

Our results showed that the trend of hair thickness and number variations during study period was significant (P < 0.001). However, there was no significant change in the hair thickness from the second injection forward. Our findings indicate the number of hair follicles during follow-up in pairwise comparison was significantly more than baseline.

CONCLUSION

Findings of our study were in line with other studies in this field and showed that the use of PRP as a new and safe treatment can be effective in androgenetic alopecia.

Real life management of chronic urticaria: Multicenter and cross sectional study on patients and dermatologists in Iran

Recently, advances in understanding the etiology of urticaria and updates of diagnostic and therapeutic management guidelines have drawn attention to chronic urticaria (CU) morbidity. The present study aimed to evaluate Iranian dermatologists' practice and real life management of CU patients. A total of 35 dermatologists and 443 patients were included in the study. Number of female patients was 321 (72.5%). Mean (standard deviation) age of the study patients was 38 (13) years and the median (inter quartile range) of disease duration was 12 (6-48) months. Severity of patients' symptoms was mild for 32.1%, moderate for 38.7%, severe for 18.8%, and 10.4% of them had no evident signs or symptoms. The most common diagnostic methods were physical examination (96.6%), differential blood count (83.5%), erythrocyte sedimentation rate (77.4%), and C-reactive protein (62.8%). The number of dermatologists prescribed nonsedating antihistamines (nsAH) in regular dose and high dose mono therapy were 26 (74%) and 6 (17%), respectively. About 66% of dermatologists were familiar with British Association of Dermatologists (BAD) guideline. The most common first-line treatment for CU by Iranian dermatologists was nonsedating antihistamines in regular or high doses. The real-life management of patients with CU in Iran was in accordance with the available practice guidelines.

Evaluation of psoriasis severity and inflammatory responses under concomitant treatment with methotrexate plus micronutrients for psoriasis vulgaris: a randomized double blind trial

INTRODUCTION

We evaluated the effectiveness of concomitant treatment with methotrexate (MTX) plus micronutrients in comparison with monotherapy with MTX only in psoriasis patients. Plasma levels of interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) were also measured and their association with clinical severity was evaluated.

METHODS

Thirty psoriasis patients 20 to 50 years old with a PASI score > 10 were divided randomly into two groups. Both groups were given oral methotrexate (0.2-0.3 mg/kg/week) for 12 weeks. In addition, Group B received one tablet of micronutrient supplement daily. Disease severity was calculated using the psoriasis area and severity index (PASI) score before and after 12 weeks. Levels of IL-1β and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA).

RESULTS

We found that 13 (86.6%) patients in Group B and 8 (53.3%) patients in Group A attained a mild PASI score (≤ 10% body involvement). IL-1β and TNF-α levels were significantly decreased in favor of Group B (p < 0.05). There was a significant correlation between changes in both IL-1β and TNF-α levels and PASI score after the study (p < 0.05).

CONCLUSION

The results obtained were positive, and therefore double-blind randomized trials with a larger sample size are highly suggested to confirm or reject these results.

Expression of Th1 and Th2 Cytokine and Associated Transcription Factors in Peripheral Blood Mononuclear Cells and Correlation with Disease Severity

BACKGROUND

Psoriasis is a T cell-mediated autoimmune disease in patients with elevated levels of proinflammatory cytokines belonging mainly to the Th1 pathway. We investigated whether treatment of psoriasis patients with methotrexate (MTX), along with micronutrients, modulated mRNA expression of Th1 and Th2 components and whether expression of these components correlated with psoriasis severity.

METHODS

Thirty plaque-type psoriasis patients with Psoriasis Area and Severity Index (PASI) scores greater than 10 were recruited; these were 15 non-micronutrients taking- (NMT) patients treated with MTX daily (0.2-0.3 mg/kg/week), and 15 micronutrients taking- (MT) patients treated with MTX plus a micronutrient supplement daily, for 12 weeks. Blood samples were collected immediately before treatment (baseline) and after 12 weeks of treatment. Taqman quantitative real-time polymerase chain reaction (qPCR) was applied to analyze the expression of the Th1 components T-bet, interleukin-12 (IL-12), and interferon-gamma (IFN-Υ), and the Th2 components GATA-3 and interleukin-4 (IL-4). Disease severity was measured using the PASI scoring system.

RESULTS

Significant clinical improvement in the MT group coincided with significant down-regulation of Th1 and up-regulation of Th2 markers (P<0.05). With respect to the PASI-75, (defined as a 75% or greater reduction in the PASI score) cut-off point, expression of IFN-γ in the MT group with PASI scores above 75 was significantly less than that of patients in the NMT group (P=0.05). Also, GATA3 and IL-4 mRNA expression in the MT group with PASI scores greater than above 75 was significantly greater than that of patients in the NMT group (P=0.05 and 0.04, respectively).

CONCLUSION

Based on significant attenuation of the PASI score, which correlated with upregulation of Th2 pathway markers in the MT group, we recommend administration of micronutrients combined with MTX for psoriasis patients. Our results contribute to a better understanding of methotrexate immunepathogenesis mechanisms and their correlations to clinical responses in psoriasis.

Serum Vitamin D3 Level in Patients with Female Pattern Hair Loss

Background:

Female pattern hair loss (FPHL) is the most common cause of alopecia in women, characterized by diffuse nonscarring hair loss in frontal, central, and parietal areas of the scalp. Pathophysiology of FPHL is still not well known, and it is probably a multifactorial genetic trait. FPHL is also observed in women without increased androgen levels, which raises the likelihood of androgen-independent mechanisms and explains the lack of response to antiandrogen treatments in some patients. Vitamin D is a factor that has recently been considered in dealing with these patients. The purpose of this study was to evaluate the serum levels of Vitamin D in patients with FPHL and compare it with healthy controls.

Methods:

In this case-control study, 45 women with FPHL were evaluated as well as the same number of healthy women matched for age, hours spent under sunlight per day, and body mass index. Serum 25(OH) D3 level was measured using ELISA.

Results:

60% of FPHL patients were in 15–30 years old age group with the mean standard deviation (SD) age of 29.11 (7.30) years. In the majority of patients (66.7%), severity of hair loss was Ludwig I. Mean (SD) serum Vitamin D3 level in patient and control group was 13.45 (8.40) and 17.16 (8.96), respectively. T-test showed a significant difference between the two groups in terms of Vitamin D3 serum levels (P = 0.04).

Conclusions:

This study indicated the correlation between the incidence of FPHL and decreased serum levels of Vitamin D3. It is recommended to evaluate serum Vitamin D3 levels as well as other hormone assays in these patients.

Frequency of Borrelia in Morphea Lesion by Polymerase Chain Reaction in Northeast of Iran

Background:

The etiology of morphea is still unknown. Borrelia spp. as a causative agent of morphea has been discussed since 1985, but the relationship remains uncertain.

Objectives:

We aimed to find the frequency of Borrelia in morphea lesions by polymerase chain reaction (PCR) in northeast of Iran.

Patients and Methods:

Sixty six patients with morphea were prospectively included in the present study. For each patient, formalin-fixed, paraffin-embedded tissue blocks of skin lesion biopsies were examined for Borrelia spp. DNA using PCR.

Results:

No Borrelia DNA was detected by PCR in skin lesions of patients with morphea.

Conclusions:

The result of this study showed no relationship between Borrelia infection and morphea lesions and in other word indicated that morphea, at least in Iran, is not caused by Borrelia spp.

Survey of bullous pemphigoid disease in northern Iran

BACKGROUND

Bullous pemphigoid is an autoimmune subepidermal blistering skin and mucous membrane disease that usually occurs in elderly people. This study was done to determine clinical features, paraclinical findings, incidence of mucosal lesions, prognosis, course of the disease, and mortality rate of patients with bullous pemphigoid.

METHOD

Retrospective descriptive study that reviews the existing files of 122 patients with bullous pemphigoid referred to dermatology clinics of Ghaem and Imam Reza hospitals in Mashhad, Iran, from 1995 to 2010.

RESULT

The majority of patients were aged between 60 and 79 years, and 53% of them were women. The major prodromal lesions were erythematous and urticarial (36.8%) and eczematous lesions (32.7%); 84.3% of patients complained of pruritus, and mucosal lesions were observed in 31.1% of patients (all in the oral mucosa). The most frequent concurrent diseases with pemphigoid were hypertension and diabetes mellitus.

CONCLUSION

Clinical features, paraclinical findings, incidence of mucosal lesions, prognosis, course of the disease, and mortality rate of bullous pemphigoid in the Khorasan region were approximately similar to results from other regions.

Evaluation between Association of Psoriasis and Vitiligo

BACKGROUND

Although the occurrence of psoriasis and vitiligo is reported in a few studies, no proper relationship has been found between these two diseases.

OBJECTIVE

The aim of this study was to identify the frequency of the coincidence of these two diseases.

METHOD

A descriptive and cross-sectional study was conducted on 6,200 patients referred to dermatology clinics from September 2004 to June 2005.

RESULTS

Among these patients, 219 and 154 patients suffered from psoriasis (3.53%) and vitiligo (2.48%), respectively, and 12 patients (0.19%) had psoriasis and vitiligo simultaneously. The coincidence in the psoriasis group was 5.48% and in the vitiligo group was 7.79%, so the coincidence of both diseases was greater than the incidence of each alone. This association was significant (p = .004).

CONCLUSION

Coincidence of these two diseases was seen, but more studies should be done to find common genetic and immunologic factors.

Comparison of Lesion Improvement in Lupoid Leishmaniasis Patients with Two Treatment Approaches

Background:

There are several therapies for treating lupoid leishmaniasis. We compared the effectiveness of intralesional meglumine antimoniate (MA) and topical application of trichloroacetic acid (TCA) 50% solution.

Methods:

This study was a randomized clinical trial comprising 60 lupoid leishmaniasis patients. The first group received intralesional MA once a week, and the second group was treated once weekly with TCA 50% topical solution. The results were recorded once after 8 weeks and then 3 months after the termination of treatment.

Results:

The total clearance rates after treatment and after the 3-month follow-up were, respectively, 48.1% and 40% in the first group and 44.4% and 36.6% in the second group. There was no significant difference between the two treatment groups ( p = .25 and p = .26). In both groups, the most common side effect was scarring.

Conclusion:

Having almost the same efficacies, TCA as a topical approach could be as effective as MA in the lupoid leishmaniasis treatment plan.

Dermoscopic features of cutaneous leishmaniasis

BACKGROUND

Previous studies have demonstrated that dermoscopy improves accuracy in diagnosing pigmented and non-pigmented tumors. Recently, there has been increasing evidence that dermoscopy can also be useful in the diagnosis of some skin infections.

OBJECTIVE

We sought to describe the dermoscopic features of cutaneous leishmaniasis.

METHOD

Dermoscopic examination (using the Derm Lite FOTO, 3Gen) of 144 CL lesions in 82 patients was performed. This study was conducted in the Imam Reza and Ghaem hospitals (Mashhad, Iran) from October 2010 to September 2011.

RESULTS

We observed the following dermoscopic features: generalized erythema (81.9%), white starbursts (60.4%), yellow hue (43.8%), yellow teardrop-like structures (41.7%), central ulcers (59%), hyperkeratosis (33.3%), and milia-like cysts (4.9%). We also observed vascular structures, including dotted vessels (61.1%), hairpin vessels (37.5%), linear irregular vessels (30.6%), comma-shaped vessels (29.9%), glomerular vessels (22.9%), arborizing telangiectasia (10.4%), and corkscrew vessels (4.2%).

LIMITATIONS

Biopsy and pathologic evaluation were not performed due to ethical considerations.

CONCLUSION

Important vascular patterns seen in melanocytic and non-melanocytic tumors were frequently observed in this infection. Dermoscopy may be a promising tool to predict the clinical course in cases of cutaneous leishmaniasis.

Study of the Association between Human T-cell Lymphotropic Virus Type 1 Infection and Lichen Planus

OBJECTIVE(S)

Lichen Planus is a common disease with unknown etiology which affects the skin and mucosa. Recent studies have focused on the possible role of the virus in the pathogenesis of Lichen Planus. The purpose of this study was to determine the association between the human T-cell lymphotropic virus type 1 and Lichen Planus.

MATERIALS AND METHODS

This case control study was conducted on a total of 200 patients. The case group consisted of 100 patients with a confirmed histopathological diagnosis of lichen planus disease, and the control group consisted of 100 healthy blood donors without any signs or symptoms of skin diseases, and who were similar in age and sex to the case group. Blood samples of both participants in the case and control groups were examined for the presence of anti -HTLV-I antibodies using the ELISA method. The polymerase chain reaction for human T-cell lymphotropic virus type 1 was conducted in cases in which the findings for antihuman T-cell lymphotropic virus type 1 antibody test was positive, and statistical analysis was conducted on the obtain results.

RESULTS

One case in the case group was infected with human T-cell lymphotropic virus type 1; however, no infection was observed in the control group. The difference was not statistically significant (P = 1).

CONCLUSION

Based on the obtained results, no association was observed between the human T-cell lymphotropic virus type 1 infection and Lichen Planus.

Comparative study of topical 80% trichloroacetic acid with 35% trichloroacetic acid in the treatment of the common wart

BACKGROUND

Common warts caused by the human papillomavirus (HPV) are considered to be the most common infectious skin disease. No individual treatment for common warts is effective as monotherapy in eradicating the lesions. The aim of this study is to evaluate the clinical efficacy of a 35% and an 80% trichloroacetic acid (TCA) solution in the treatment of the common wart.

METHODS

In this single-blinded clinical trial, 62 eligible patients with common warts referred to the dermatology clinic of Ghaem Hospital in Mashhad, Iran. Patients were randomly divided into two groups, each treated with a TCA solution (group A, TCA 80%; group B, TCA 35%) once per week until complete clearance of the lesions or for a maximum duration of six weeks. Seven patients were excluded from the final analysis (one patient in group A and six patients in group B) for various reasons, including irregular follow-up, using physical tools such as razor blades to remove the lesion, and failure to complete treatment; and 55 patients were included in the final analysis.

RESULTS

Improvement to treatment responses was classified as: no change (no changes in the number of warts), mild (clearing of less than 25% of warts), moderate (clearing of 25% to 75% of warts), and good (clearing of more than 75% of warts). At the end of follow-up, the clinical improvement of group A (n=30) was: 10 patients (33.3%) with a mild response, 6 patients (20%) with a moderate response, and 14 patients (46.7%) with a good response. In group B (n=25), 16 patients (64%) showed a mild response, 6 patients (24%) a moderate response, and 3 patients (12%) a good response. There was a statistically significant difference in improvement between the two treatment groups (P=.017). Improvement was greater with a higher concentration of TCA solution.

CONCLUSION

This study showed that a different concentration of TCA solution was an effective form of treatment for common warts. Trichloroacetic acid 80% is more effective, but this solution must be used only with careful consideration by a physician.

Efficacy of suction blister epidermal graft without phototherapy for locally stable and resistant vitiligo

INTRODUCTION

Surgical methods for treatment of vitiligo include punch grafts, blister grafts, follicular grafts and cultured melanocyte grafts. The aim of this study was to determine the efficacy of suction blister grafts for treatment of vitiligo, without the use of phototherapy.

MATERIALS AND METHODS

This clinical trial study was conducted on 10 patients with vitiligo that was resistant to usual treatments and with limited involvement in the affected sites. We used cryotherapy and a manual suction device for blistering at the recipient and donor sites, respectively. The blister was separated and fixed with sutures and a dressing to the recipient site. Repigmentation of lesions was evaluated monthly for 6 months after treatment. Repigmentation rates higher than 90%, between 71%-90%, from 51%-70%, and less than 50% were graded as complete, good, moderate, and poor, respectively.

RESULTS

Ten patients (five females with a mean age of 23.2±3.96 years and five males with a mean age of 30.60±4.15 years) were enrolled in the study. Reponses to treatment after a 6-month follow-up were 'complete,' 'good,' and 'moderate' in 7 (70%), 1 (10%), and 2 (20%) patients, respectively.

CONCLUSION

With this technique, patients with restricted sites of involvement, that did not respond to the usual treatments showed very good repigmentation without any additional phototherapy over a 6-month follow-up; moreover, there were no side effects such as scarring.

Evaluation of the effect of formic acid and sodium formate on hair reduction in rat

Hirsutism is a common problem in dermatology that imposes high socioeconomical costs on medical care. Consequently, researchers are actively searching for cheaper and safer methods for therapeutic treatment. The objective of the present study is to evaluate formic oil, enriched from formic acid, for the removal of unwanted hair. In this study, 32 female rats (150-200 g) were randomly divided into four groups and maintained with normal water and food availability. A patch of skin was shaved on each rat for application of test solutions. The control group was treated with local once-daily applications of normal saline. The formic acid, acetic acid, and sodium formate groups were treated with once-daily applications of formic acid (pH 5.5), acetic acid (pH 5.5), or sodium formate, respectively. After 2 weeks, horizontally cut sample biopsies were removed, and the numbers of hair follicles were counted under high field microscopy by a specialist blinded to the treatments. Kolmogorov-Smirnov test results indicated a nonparametric distribution for the rat groups. ANOVA analysis indicated no statistically significant differences between groups (P < 0.05). There weren't any side effects or evidence for toxicity during the study period. However, hair follicle counts showed a descending order of control, acetic acid, formic acid, and sodium formate. Although the sodium formate group had the lowest hair follicle numbers, the difference was not statistically significant (P > 0.05). Formic acid was not effective in reducing hair follicle numbers in rats.

Oral submucous fibrosis in a young patient

A seventeen-year-old male presented with a restriction in the oral cavity. The oral mucosa was white and he could not protrude his tongue. For 4 years he had habitually held a powdery material containing betel nut in the oral vestibule for several minutes a day. A biopsy of the labial mucosa was carried out and a diagnosis of oral submucous fibrosis was confirmed. This is a premalignant condition. Oral submucous fibrosis is very rare in young patients.

Efficacy of 80% phenol solution in comparison with cryotherapy in the treatment of common warts of hands

INTRODUCTION

The common wart is a common infectious disease caused by human papilloma virus. A variety of therapeutic modalities are available. Cryotherapy (liquid nitrogen) is one of the most common treatment forms. It freezes the tissue and destroys warts. Phenol is a caustic agent. Our purpose was to evaluate and compare the efficacy of cryotherapy and 80 percent phenol solution on common warts of hands.

METHODS

This single-blinded clinical trial study was performed on 60 patients with common warts referred to the dermatology clinic of Ghaem Hospital Mashhad, Iran, in 2002. Patients were randomly divided into two groups; 30 patients were treated with cryotherapy and 30 patients were treated with 80 percent phenol, on a once-weekly basis until complete clearance of the lesions or a maximum duration of six weeks.

RESULTS

Complete clearance of warts after six weeks was observed in 70 percent of patients who were treated with cryotherapy, and 82.6 percent of patients in the 80 percent phenol group; there was no statistically significant difference between the two methods (p-value is 0.014).

CONCLUSION

Our data indicates that 80 percent phenol and cryotherapy are effective and simple treatments for common warts of hands, and patients do not experience any pain during the treatment.

Risk of Viral Transmission Via Bone Marrow Progenitor Cells Versus Umbilical Cord Blood Hematopoietic Stem Cells in Bone Marrow Transplantation

Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for children and certain adults with malignant and nonmalignant hematologic disease. Since viral infections are the major problem, this study examined those that might potentially be transmitted to HSCT recipients via bone marrow (BM) versus umbilical cord blood (UCB). BM progenitor cells, peripheral blood leukocytes, and plasma samples were collected from 30 allogenic BM donors. Umbilical cord blood hematopoietic stem cells and plasma samples were also collected from 34 UCB donors. Viral DNA extracted and purified from collected specimens was processed using nested polymerase chain reactions (PCR) to detect human parvovirus B19 (HPV B19), human herpesvirus-6 (HHV-6), varicella-zoster virus (VZV), human cytomegalovirus (HCMV), and Epstein-Barr virus (EBV). The prevalences of HCMV DNA in collected BM progenitor cells versus UCB hematopoietic stem cells were 73% versus 23%, respectively. Conversely, HHV-6 DNA was not detected in any collected specimen by simple PCR. Distribution of the other investigated virus DNAs except EBV DNA was similar in specimens collected from both groups. EBV DNA was not determined in UCB hematopoietic stem cells. The results indicate that the risk of viral transmission to BM transplant recipients via UCB hematopoietic stem cells is less than that with BM progenitor cells.

Outcome of Hepatitis B and C Virus Infection on Graft Function After Renal Transplantation

INTRODUCTION

Chronic liver disease resulting from hepatitis B virus (HBV) and hepatitis C virus (HCV) infections is still a major concern in kidney recipients. It is unclear whether HCV antibody status and markers of HBV infection are associated with renal dysfunction. Thus, we designed a study to investigate the incidence of HBV and HCV infection after renal transplantation and whether these infections alter graft function.

METHODS

Fifty-eight patients who underwent renal transplantation participated in the study. Serum creatinine and aminotransferase levels were measured with standard automated analyzers. Anti-HCV antibodies were detected with an enzyme immunoassay, and a reverse transcriptase-polymerase chain reaction (RT-PCR) technique was used to test for HCV-RNA. Serological markers for HBV (HBsAg and anti-HBc antibody) were detected by enzyme immunoassay. All samples from patients who were seropositive for HBsAg or anti-HBc antibody were PCR-tested for HBV-DNA. A serum sample collected from living donors was tested for anti-HCV antibodies and serological markers for HBV. Serum creatinine and aminotransferase levels were also measured in living donors.

RESULTS

Anti-HCV was not detected in serum samples of any cases before transplantation. However, 10 (17.2%) tested positive after transplantation. HCV-RNA was detected in 2 of the 10 patients (3.4% of all patients). None of the pretransplantation serum samples tested positive for HBsAg. However, anti-HBc antibody was identified in 8 (13.8%) of the 58 patients.. No HBV DNA was detected in serum samples of the patients with anti-HBc or HBsAg-positive. HBsAg was only detected in 1 (1.7%) recipient after transplantation. None of the 58 patients showed clinical signs or symptoms of renal dysfunction during the study period.

CONCLUSION

Our data suggest that, neither HBV nor HCV infection appears to cause or contribute to renal dysfunction in the early period (1 year) after renal transplantation. Nevertheless, a long-term consequence of chronic HBV or HCV liver disease or graft loss is not impossible in renal transplant recipients.

Incidence of Reactive Antibodies Against Epstein-Barr in a Group of Renal Transplant Patients

Epstein-Barr virus (EBV) infection which is common among immunocompromised patients, may lead to life threatening lymphoproliferative diseases. In this study we examined the incidence and serologic status of EBV infection in 116 renal transplant patients including 84 males and 32 females as well as 72 normal volunteers. The time interval between transplantation and sampling was 1 month to 10 years. Twenty-two patients had a history of rejection. All cases were first transplants except for 3 second transplants. Four patients and no normals showed a positive PCR by a qualitative method. VCA IgM was positive in 11/116 patients (0.09%) and 3 of 72 (0.04%) normal volunteers. 99% (115/116) and 98% (65/72) of patients and normal controls were positive for VCA IgG. EA IgG was positive in 36/116 (31%) and 13/72(18%) of patients and normals, respectively. EBNA IgG was positive in 113/116 (97%) and 100% of patients versus normal controls, respectively. In all except one case with a positive VCA IgM there was a history of infectious mononucleosis-like syndrome. According to our previous data in more than 1000 renal transplant patients during more than 10 years, only one case of PTLD has been diagnosed (0.1%) which is lower than that reported. The high incidence of EBV seropositivity may contribute to this low incidence. The rate of EBV seropositivity in renal transplant patients was greater than in the normal population (P = .05). No association was observed between PCR and seropositivity and rejection or the type of treatment. After this study we began routine PCR and antibody testing in all renal transplant patients both pre- and posttransplant to determine the exact rate of reactivation versus primary infection which we plan to evaluate after 2 to 3 years. In conclusion we believe that the best easiest method to detect EBV infection in immunocompromised patients is VCA IgM ELISA; a qualitative PCR alone is not sufficient for this evaluation.