Vasant Sumethkul - Academia.edu (original) (raw)

Papers by Vasant Sumethkul

Transplantation, 2017

Backgrounds Kidney organ shortage is a major problem for transplant communities around the world.... more Backgrounds Kidney organ shortage is a major problem for transplant communities around the world. Kidneys from expanded criteria donors (ECD) is increasingly accepted and widely used by many transplant programs. However, kidney allograft survivals from ECD is believed to be lower compared to standard criteria donors (SCD) due to lower nephron numbers. Objectives To demonstrate factors correlated with poor allograft survival from ECD. Methods Using Thai transplantation registry data from 1994 to 2016, 2,886 adults (>18 years) first deceased donor kidney transplant recipients were included into the study. Of those, 242 (8.39%) were kidney transplantation from expanded criteria donor which was defined as donor age of more than 60 year or donor age between 50 to 60 years with two of the following characteristics including history of hypertension, last serum creatinine of more than 1.5 mg/dl, and death from stroke. Results Mean recipient age and donor age were significantly higher in ECD group (for recipient age, 48.6±11.8 vs 44.7±11.3 years in SCD group, p<0.001; for donor age, 60.1±5.7 vs 34.5±13.0 years in SCD group, p<0.001). Not surprisingly, cold ischemic time (CIT) is longer in ECD group (20.2±5.0 vs 19.0±6.5 hours in SCD group, p=0.006) and delayed graft function is higher (59.7% vs 42.4%, p<0.001). ECD group increased risk of allograft loss when compared to SCD group (HR 2.19, 95% CI 1.65 to 2.91, p <0.001). However, in patients with CIT of less than 18 hours, the effects of ECD was disappeared (HR 1.58, 95% CI 0.83 to 3.01, p=0.165), compared to group of patients with CIT of more than 18 hours (HR 2.29, 95% CI 1.61 to 3.24, p <0.001) as shown in the figure. Conclusions Kidney transplantation from ECD increases the risk of allograft failure. However, this effect is vanished if CIT is less than 18 hours. Transplant coordinators from 31 kidney transplant centers across Thailand. Figure. No caption available.

Transplantation Proceedings, 2000

Transplantation proceedings, 1992

Transplantation proceedings, 2008

Transplantation Proceedings, 2014

Background. The Thai Kidney Transplant (TKT) program was launched in October 2008 to promote tran... more Background. The Thai Kidney Transplant (TKT) program was launched in October 2008 to promote transplantation among previously disadvantaged populations, using fixed-rate provider payment. This study investigated if the introduction of this program could alter the natural practice trends of immunosuppressive drug use. Methods. Data from the Thai Transplantation Registry were analyzed. The change in trend of immunosuppressive use was assessed using the multivariate adaptive regression splines (MARS) technique. Results. During 1987e2012, 3975 kidney transplantations were done. The average age of patients was 42 years and 62% were male. Chronic glomerulonephritis accounted for one third of those with known causes of end-stage renal disease (ESRD). Eighty-six percent were on hemodialysis before transplantation. Prednisolone was used in 95.87% of all transplant recipients, whereas calcineurin inhibitors (CNIs), mycophenolates (MPAs), azathioprine (AZA), and mammalian target of rapamycin inhibitors (mTORis) were used in 95.67%, 64.22%, 12.25%, and 2.31%, respectively. Overall use after 2008 was decreased for AZA (18.16% to 3.40%) and mTORis (2.86% to 1.5%) but increased for MPAs (50.80% to 84.34%), CNIs (95.43% to 96.04%), and prednisolone (95.60% to 96.29%), as compared with before the program inception. The slopes of use trends of AZA, MPAs, and CNIs did not significantly marginally differ from their natural trends before the program inception (P ¼ .496, .108, and .741, respectively). However, the natural increasing use trend of mTORis significantly changed to a decreasing pattern after the introduction of the TKT program (P ¼ .018). Conclusion. Fixed-rate provider payment might interfere with the natural practice trends of immunosuppressive drug use.

Transplantation Proceedings, 2002

Transplantation proceedings, 1996

Pediatric Transplantation, 2013

The Southeast Asian journal of tropical medicine and public health, 1996

Analgesic abuse is common in Thailand. Heavy use of analgesic may also increase risk of chronic n... more Analgesic abuse is common in Thailand. Heavy use of analgesic may also increase risk of chronic nephropathy. However, the extent of this risk remains unclear. We carried out a case-control study in three referral hospitals. A total of 84 patients with newly diagnosed of chronic tubulointerstitial nephritis were enrolled as cases. Two control groups were randomly selected, 192 from hospitalized patients who had no renal disease and serum creatinine below 1.2 mg/dl and 166 from relatives of friends visiting the hospitals. Both cases and controls were interviewed by a standardized pre-coded questionnaire to obtain histories of analgesic use before diagnosis of renal disease. On multiple logistic regression analysis, patients whose estimated lifetime use of acetaminophen of 1,000 g or more had an increased risk of chronic nephropathy compared with non-users, the odds ratio (OR) was 5.9 (95% confidence interval (CI) 1.3-25.6, hospital controls) and OR = 5.8 (95% CI 1.04-31.9, visitor con...

Lupus, 2017

We conducted a prospective multicenter, opened-label, parallel, randomized, controlled trial to c... more We conducted a prospective multicenter, opened-label, parallel, randomized, controlled trial to compare tacrolimus (TAC) and mycophenolate mofetil (MMF) for induction and maintenance therapy in lupus nephritis (LN). Adult patients with biopsy-proven LN International Society of Nephrology/Renal Pathology Society classes III-V and active nephritis were to receive prednisolone (0.7-1.0 mg/kg/day for four weeks of run-in period and tapered) and randomly assigned to receive TAC (0.1 mg/kg/day) or MMF (1.5-2 g/day) as induction therapy for six months. All patients who had remission received azathioprine (AZA) 1-2 mg/kg/ day as standard treatment in the maintenance phase. The primary outcome was Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) at six and 12 months, and the secondary outcomes included renal SLEDAI, non-renal SLEDAI, modified SLEDAI-2K, immunity SLEDAI, and disease activity remission. Eighty-four patients were randomized. One patient who was randomized to the TAC group withdrew from the study immediately after randomization. Therefore, 42 patients received MMF and 41 patients received TAC. Disease activity remission rate and time to disease activity remission were similar in both groups. Twelve patients (28.57%) in the MMF group and 10 patients (24.39%) in the TAC group achieved disease activity remission. For disease activity scores, both regimens significantly improved SLEDAI-2K during induction and maintenance therapy. Overall, SLEDAI-2K score in the MMF group decreased more compared with the TAC group. In the MMF group, mean SLEDAI-2K decreased from 11.6 AE 4.8 to 6.3 AE 3.9 after induction therapy and to 5.4 AE 4.4 after maintenance therapy. In the TAC group, mean SLEDAI-2K decreased from 9.0 AE 3.7 to 6.3 AE 5.1 after induction therapy and to 7.1 AE 5.4 after maintenance therapy. Renal SLEDAI and modified SLEDAI-2K showed a similar pattern with SLEDAI-2K. In non-renal SLEDAI and immunity SLEDAI, both regimens also resulted in decreased disease activity scores during the first two months. After that the scores were slightly increased. In the MMF group, the scores were still lower than baseline but in the TAC group were not. In conclusion, disease activity remission rate was similar in the MMF and TAC groups. For disease activity score as measured by SLEDAI-2K, TAC was comparable with MMF during induction but MMF was more effective on disease activity of active LN classes III and IV at 12 months, especially in the renal system. Lupus (2017) 0, 1-10.

Transplantation Proceedings, 2016

Background. The impact of specific HLA antibodies on the allograft function in the Luminex era is... more Background. The impact of specific HLA antibodies on the allograft function in the Luminex era is not clearly known. This study aimed to investigate kidney transplantation outcomes in patients with different anti-HLA antibody status as detected by Luminex PRA. Methods. This retrospective study included 106 deceased-donor kidney transplantation (DDKT) patients divided into 3 groups by PRA status as detected by PRA-bead: (1) PRA ¼ 0; (2) positive PRA but with negative antibody against donor's HLA antigens; and (3) positive PRA with positive anti-HLA antibody specificity against donor's HLA antigens. Results. There were 65, 23, and 18 patients in groups 1, 2, and 3, respectively. Early allograft rejections were highest in group 3 (22.2%) (P ¼ .02). In multivariate analysis, delayed graft function was the only factor that was associated with allograft rejection (hazard ratio, 8.9; 95% confidence interval, 1.9e39.8; P ¼ .004). Estimated glomerular filtration rates at 1 year of the 3 groups were 54.6, 55.8, and 60.0 mL/min (P ¼ .71). One-year allograft failure and death were not different among the 3 groups. Expanded-criteria deceased donors were associated with both allograft failure (P ¼ .003) and patient death (P ¼ .02). Conclusions. Anti-HLA antibody as detected by Luminex PRA was associated with early allograft rejection but not graft or patient survival. The effect of newer treatment modalities can improve the outcomes of PRA-positive patients to be similar to nonsensitized patients at 1 year.

Transplantation, 2008

of chronic liver disease was 18.5%. Hepatitis B and C infection signifi cantly increased the prev... more of chronic liver disease was 18.5%. Hepatitis B and C infection signifi cantly increased the prevalence rate of chronic liver disease. The treatment of lamivudine obviously reduced the development of hepatitis B related fulminant hepatic failure. Post-transplant diabetes was diagnosed in 15.9% patients. The logistic regression analysis revealed that hepatitis C infection, age, and fi rst month the blood trough level of tacrolimus were the independent risk factor for post-transplant diabetes. In summary, we have demonstrated that tacrolimus and mycophenolic acid based regimen is effective as a primary regimen in KTx recipients with or without hepatitis B and C infection. KTx recipients with hepatitis C, but not hepatitis B, infection may have poor long term graft survival. The use of lamivudine can modify the natural course of hepatitis B infection in kidney transplant recipients.

Transplantation Proceedings, 2004

Anti-IL-2 receptor has been proved to be effective in reducing the rate of acute rejection in kid... more Anti-IL-2 receptor has been proved to be effective in reducing the rate of acute rejection in kidney transplantation and also improving both the rate of graft and patient survival. In this study, we retrospectively review the role of anti-IL-2 receptor as induction immunosuppression in immunologically high-risk kidney transplant patient compared with normally low-risk patients. Methods. From January 1999 to December 2002, we performed 246 kidney transplantations in two transplant centers in Bangkok. These were divided into two groups: group 1, high-risk group containing 50 patients who had one of the following criteria: (1) high panel reactive antibody (Ͼ50%); (2) retransplantation; (3) marginal donor (with expectancy of delayed graft function); (4) spouse donor; (5) Ͼ4 HLA mismatch. All group 1 patients receive anti-IL-2 receptor as induction immunosuppression (either Basiliximab (n ϭ 27) or Daclizumab (n ϭ 23).) Group 2 consisted of the control group of 196 patients with normal immunological risk. The following data of both groups were collected and analyzed: patient demography, type of donor, acute rejection incidence, severity, and time. Results. In this study, the anti-IL-2 receptors are 27 cases of Basiliximab and 23 cases of Daclizumab. The rates of acute rejection are not significantly different in both groups, namely, 46 of 194 (23.7%) in group 2 compared with 10 of 50 (20%) episodes in group 1 (P ϭ .602). All rejections in both groups responded to pulse steroid treatment. The mortality rate and rate of graft failure were also not significantly different, i.e., 6 of 196 (3.1%) vs 2 of 50 (4.0%) (P ϭ .666) and 7 of 196 (3.6%) vs 3 of 50 (6.0%) (P ϭ .429) in low risk group versus high risk group, respectively. Kaplan-Meier estimates of the probabilities of acute rejection free, patient survival rate, and graft survival rate also showed no difference between groups. Conclusions. The use of anti-IL-2 receptor antibodies as induction immunosuppression in immunologically high-risk patients results in the same rate of acute rejection, severity of acute rejection, graft survival, and patient survival as recipients with normal immunological risk.

Transplantation Journal, 2010

Background. Kidney transplantation is the most performed solid organ transplantation in Thailand.... more Background. Kidney transplantation is the most performed solid organ transplantation in Thailand. Over 4000 patients have received kidney transplantation from 23 centers within the kingdom. This study sought to demonstrate the causes of graft loss and death in Thai patients receiving kidney transplant during the past decade. Patients and Methods. The Thai Transplant Registry database was used to evaluate the causes of graft loss and death. This database was established since 1997, a total of 2298 kidney transplants were available for analysis. Graft loss was defined as return to dialysis, graft removal, retransplantation, or death of the recipients. Patient survival was analyzed by all deaths. Results. Among 2298 recipients, 59% received organs from deceased donors. The mean age at transplantation was 42 years (SD 12) and 61% were male. The most common identified causes of the end-stage renal disease were chronic glomerulonephritis (25.3%) and hypertensive nephropathy (11.3%); half of those were unknown. Actuarial graft survival rates at 1 and 5 years were 89% and 73%, respectively. The common causes of graft loss were chronic allograft nephropathy (53%), acute rejection (15%), death with a functioning graft (15%), and transplant renal artery diseases (7%). The greatest proportion (64%) of deaths was infection owing to septicemia and/or pulmonary infection. The others were from cardiovascular deaths (12%), liver disease (6%), and malignancy (4%). Conclusion. Graft survival rates were comparable with previous reports. However, the proportion of death with functioning graft and cardiovascular death as a cause of graft and patient loss is lower than that of Caucasian populations.

Transplantation Proceedings, 2001

Fig 1. The progression to ESRD of recurrence Ig AN is significantly faster than that of native Ig... more Fig 1. The progression to ESRD of recurrence Ig AN is significantly faster than that of native Ig AN (see text).

Additional file 7: Figure S4. The dose–effect relationship of perioperative Hb decrement on the o... more Additional file 7: Figure S4. The dose–effect relationship of perioperative Hb decrement on the occurrence of PEGF in DDKT patients (n = 126). The influence of perioperative Hb decrement, at each cut-off, was adjusted by the cause of ESRD, recipient baseline creatinine, Pretransplant PRA, donor age, donor gender, WIT, CIT and EBL as presented in Table 3.

Additional file 4: Table S1. Area under the curve (AUC), sensitivity and specificity of the selec... more Additional file 4: Table S1. Area under the curve (AUC), sensitivity and specificity of the selected cut-point of perioperative Hb change, the percentage of Hb decrement, baseline pre-transplant hemoglobin and postoperative hemoglobin levels.

Additional file 2: Figure S2. Comparison between patients with poor early graft function (PEGF; n... more Additional file 2: Figure S2. Comparison between patients with poor early graft function (PEGF; n = 98) and immediate graft function (IGF; n = 171). A. Perioperative hemoglobin change was defined by the difference between post-operative and pre-operative hemoglobin concentrations (details in "Materials and Methods" section). B. The percentage of hemoglobin decrement was calculated by 100*[pre-transplant hemoglobin – postoperative hemoglobin]/pre-transplant hemoglobin. C. A scatter plot showed a linear correlation between both parameters. The dashed blue line represented the selected cut-points based on Receiver Operating Characteristics (as shown in Table S1). Red color dots represent patients with PEGF, whereas grey color dots represent patients with IGF. Visually, both hemoglobin decrement measures associated with an increasing trend of PEGF. Data were presented as median and interquartile range [IQR]. P-value

Additional file 5: Table S2. Sensitivities and specificities of all threshold of various Hb param... more Additional file 5: Table S2. Sensitivities and specificities of all threshold of various Hb parameters including perioperative Hb change, the percentage of Hb decrement, baseline pre-transplant hemoglobin and postoperative hemoglobin levels.

Additional file 1: Table S1. Effects of sevoflurane and desflurane anesthesia on plasma cytokine ... more Additional file 1: Table S1. Effects of sevoflurane and desflurane anesthesia on plasma cytokine levels of LDKT patients.