Ching-Yao Cheng

BACKGROUNDS: Variability of blood trough concentration (C0) in immunosuppressant leads to rejection and graft loss after kidney transplantation. METHODS: The aim of this study is to prospectively investigate the change of within-patient variability among stable kidney transplant recipients with conversion from twice-daily Prograf to the same milligram-for-milligram daily dose of once-daily Advagraf. RESULTS: The mean age of 129 patients was 51.3±12.1 years. The conversion to Advagraf was administrated at 6.3±4.8 years after transplantation. The daily dose was changed from 4.7±2.0 mg to 4.9±2.1 mg after conversion. Only six patients increased daily dose by 16.7% to 25% to maintain target levels. The whole blood C0 of tacrolimus before conversion was 5.9±1.7 ng/mL. The mean C0 was significantly reduced after conversion to Advagraf; it was 4.9±1.5 ng/mL on the seventh day (P<0.001) and 5.4 to 5.5 ng/mL at 1 to 6 months (P<0.05). Forty-one (31.8%) patients have reduced C0 of more than 25% on the seventh day. The percent coefficient of variation of tacrolimus C0 more than 22.5% before conversion is associated with higher risk of reduced C0 after conversion (P<0.05). Compared with before conversion, less kidney transplant recipients have percent coefficient of variation more than 22.5% after conversion (3.1% vs. 17.4% with P<0.01). CONCLUSIONS: The results support that conversion from Prograf to Advagraf among kidney transplant recipient leads to a significantly lower C0 and within-patient variability of tacrolimus C0. The within-patient variability of C0 before conversion influences C0 on the sevent day after conversion to Advagraf.

INTRODUCTION: Contrast-induced acute kidney injury (CI-AKI) is associated with high risks of morbidity and mortality. Hyperbilirubinemia might have some renal protection but with no clear cutoff value for protection. Related studies are typically on limited numbers of patients and only in conditions of vascular intervention. METHODS: We performed this study to elucidate CI-AKI in patients after contrast-enhanced computed tomography (CCT). The outcomes were CI-AKI, dialysis and mortality. Patients were divided to three groups based on their serum levels of total bilirubin: ≤1.2 mg/dl, 1.3-2.0 mg/dl, and >2.0 mg/dl. RESULTS: We enrolled a total of 9,496 patients who had received CCT. Patients with serum total bilirubin >2.0 mg/dl were associated with CI-AKI. Those undergoing dialysis had the highest incidence of PC-AKI (p<0.001). No difference was found between the two groups of total bilirubin ≤1.2 and 1.3-2.0 mg/dl. Patients with total bilirubin >2mg/dl were associated with CI-AKI (OR = 1.89, 1.53-2.33 of 95% CI), dialysis (OR = 1.40, 1.01-1.95 of 95% CI) and mortality (OR = 1.63, 1.38-1.93 of 95% CI) after adjusting for laboratory data and all comorbidities (i.e., cerebrovascular disease, coronary artery disease, peripheral arterial disease, and acute myocardial infarction, diabetes mellitus, hypertension, gastrointestinal bleeding, cirrhosis, peritonitis, ascites, hepatoma, shock lung and colon cancer). We concluded that total bilirubin level >2 mg/dl is an independent risk factor for CI-AKI, dialysis and mortality after CCT. These patients also had high risks for cirrhosis or hepatoma. CONCLUSION: This is the first study providing evidence that hyperbilirubinemia (total bilirubin >2.0 mg/dl) being an independent risk factor for CI-AKI, dialysis and mortality after receiving CCT. Most patients with total bilirubin >2.0mg/dl had cirrhosis or hepatoma.

Cu(C10H8N2)(CI0H8N2)(C104)2) , Mr = 574.5, orthorhombic, Pbcn, a=12.413(3), b = 14.645 (3), c = 12.287 (2) , V = 2233.6 (8) A 3, Z = 4, Dx = 1.708 g cm -3, A(Mo Kte) = 0.71069 ,~, /z = 13.12 cm- 1, F(000) = 1164, room temperature, R = 0.050 and wR = 0.049 for 1498 observed reflections. The coordination around Cu n is an elongated dis- torted octahedron. Two N atoms of 2,2'-bipyridyl and two N atoms from two 4,4'-bipyridyls form the equatorial coordination plane, and two perchlorate ions occupy the axial sites. The 4,4'-bipyridyl ligand bridges neighbouring Cu n atoms to form polymeric chains along the c axis in the crystal. The rings of 4,4'-bipyridyl are coplanar and make a dihedral angle of 114 ° with the equatorial coordination plane; the 4,4'-bipyridyl may provide a pathway for mag- netic superexchange interaction between the adjacent Cu ~I atoms. Introduction. In the last decade, a number of binu- clear transition-metal complexes bridged by hetero- cyclic aromatic diamines have been investigated as * To whom correspondence should be addressed.