nystatin-a1 and Diabetes-Mellitus

Concern persists that prednisone-free maintenance immunosuppression in kidney transplant recipients will be associated with an increase in late allograft dysfunction and graft loss. We herein report 5-year follow-up of a trial of prednisone-free maintenance immunosuppression. From October 1, 1999, through January 31, 2005, at our center, 589 kidney transplant recipients were treated with a protocol incorporating discontinuation of their prednisone on postoperative day 6. At 5 years, actuarial patient survival was 91%; graft survival, 84%; death-censored graft survival, 92%; acute rejection-free graft survival, 84% and chronic rejection-free graft survival, 87%. The mean serum creatinine level (+/-SD) at 1 year was 1.6 +/- 0.6; at 5 years, 1.7 +/- 0.8. In all, 86% of kidney recipients with functioning grafts remain prednisone-free as of April 30, 2005. As compared with historical controls, recipients on prednisone-free maintenance immunosuppression had a significantly lower rate of a number of complications, including cataracts (p < 0.001), posttransplant diabetes mellitus (p < 0.001), avascular necrosis (p = 0.001), and fractures (p = 0.004). We conclude that prednisone-related side effects can be minimized in a protocol incorporating prednisone-free maintenance immunosuppression. Five-year graft outcome remains good.

Topics: Anti-Infective Agents; Antifungal Agents; Antiviral Agents; Cataract; Clotrimazole; Cohort Studies; Creatinine; Dapsone; Diabetes Mellitus; Fractures, Bone; Ganciclovir; Graft Rejection; Graft Survival; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Necrosis; Nystatin; Pentamidine; Prednisone; Time Factors; Transplantation, Homologous; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Valganciclovir

Buccal epithelial cells (BEC) from 12 patients with diabetes mellitus and 12 age- and sex-matched non-diabetic subjects were tested in vitro for adhesion of Candida albicans following exposure to nystatin both in vitro and in vivo. Adhesion was significantly reduced (P < 0.002) to cells from both the diabetic and non-diabetic subjects after in vitro exposure to nystatin, but the reduction in adhesion was variable (5.0-50.7% in control subjects and 0.5-48.4% in diabetic subjects) and equivalent between the two groups. In vivo exposure to nystatin produced no overall significant reduction in candidal adhesion to cells from either diabetic or control subjects.

Topics: Adult; Antifungal Agents; Candida albicans; Candidiasis, Oral; Case-Control Studies; Cell Adhesion; Diabetes Complications; Diabetes Mellitus; Epithelial Cells; Epithelium; Female; Humans; Male; Mouth Mucosa; Nystatin

Topics: Adolescent; Candidiasis, Vulvovaginal; Child; Diabetes Mellitus; Drug Therapy; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Metronidazole; Nystatin; Pregnancy; Trichomonas Vaginitis; Uterine Cervicitis; Vaginitis; Varicose Veins; Vulvar Neoplasms; Vulvitis; Vulvovaginitis

Topics: Diabetes Mellitus; Esophagitis; Esophagoscopy; Humans; Nystatin; Yeasts