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Background The use of potent immunosuppression increases the risk of infectious complications following kidney transplantation. Sulfamethoxazole-trimethoprim ( SMX/ TMP) is an inexpensive broad-spectrum antimicrobial agent used in our center as lifelong prophylaxis against Pneumocystis jirovecii, unless contraindicated. This study evaluated the clinical impact of SMX/ TMP prophylaxis compared with no prophylaxis with SMX/ TMP (No PPx), but with alternative agents. Methods This was a retrospective cohort analysis of renal transplant recipients ( RTR) transplanted from January 2002 through December 2010. Patients were divided into SMX/ TMP group and No PPX group, based on whether they received prophylaxis with SMX/ TMP or not, and rates of sepsis were compared between groups. We also analyzed the pathogens and source implicated in these episodes, as well as the dose of SMX/ TMP. Rates were compared using multivariate logistic regression. Results With a mean follow-up of 4.8 (± 2.5) years, 63 cases of sepsis occurred in 1224 patients (5.1%), and 60% of these cases had a urinary source. The risk of sepsis was significantly reduced with prophylaxis vs. No PPx (13.3% vs. 4.3% for SMX/ TMP, P < 0.001), and this association was maintained through multivariate regression. Sepsis was associated with a numerically increased risk of graft loss and death that was not significantly affected by use of SMX/ TMP. Conclusions Prophylaxis with SMX/ TMP is an inexpensive way to reduce the incidence of sepsis in RTR. [ABSTRACT FROM AUTHOR]

We identified 22 cases of influenza infection among renal transplant recipients and matched them with 66 controls by influenza season to explore risk factors for influenza infection. Active cigarette smoking was associated with influenza infection in this population (adjusted odds ratio 13.1; 95% confidence interval 2.3-76; P = 0.004). [ABSTRACT FROM AUTHOR]

Objective: To compare patient survival, graft survival and financial costs at 3 years after renal transplant in graft recipients who received pre-emptive or deferred treatment of cytomegalovirus (CMV) disease. Clinical outcomes and CMV-related charges at an average of 16 months' follow-up have been reported previously. Design and Setting: This was a randomised, nonblind trial in patients enrolled between June and December 1994 at a single US centre. Patients and Participants: 36 adult renal transplant recipients who themselves, or their donors, were CMV-seropositive were randomised into 15 patients in the pre-emptive treatment group and 21 patients in the deferred treatment group. Methods: Patients in the pre-emptive treatment group received intravenous ganciclovir 5 mg/kg every 12 hours once CMV viraemia was detected. Patients in the deferred treatment group received the same intravenous ganciclovir regimen after developing symptomatic CMV disease. Cost data were collected for inpatient hospitalisations, outpatient intravenous medications and dialysis treatments. Results: A comparison of the descriptive characteristics of the two groups revealed no significant differences. Three of 15 patients in the pre-emptive group died with graft function during the third year post-transplant, whereas none of 21 patients in the deferred group died during the study. However, none of the 3 deaths appear to be causally related to the study (myocardial infarction, lung cancer and homicide). Estimates of graft failure, censored for death with function, show a trend towards more graft loss in the deferred treatment group (p = 0.089). Average treatment costs were not significantly different during the first year post-transplant. However, by the third year post-transplant, costs were significantly higher in the deferred group (an additional $US15 277/patient, p < 0.001). Conclusions: With an average of 16 months' follow-up and an assessment of CMV-related charges, it was concluded that the deferred strategy was preferred because of equivalent clinical outcomes at lower CMV treatment charges. The results of the current study with 3-year follow-up and an analysis of total post-transplant treatment costs reverses the previous conclusion. We now conclude that a pre-emptive strategy for treating CMV disease is preferred because of similar clinical outcomes with lower total medical costs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the economic implications for transplant centres, Medicare and society of treatment of corticosteroid-resistant Banff Grades I, II and III acute kidney transplant rejection with the antithymocyte globulins Thymoglobulin or Atgam.Design and Setting: This was a cost analysis of a randomised double-blind multicentre clinical trial comparing the safety and efficacy of Thymoglobulin and Atgam that was performed at 25 centres in the US in 1994 to 1996.Patients and Participants: The study enrolled 163 patients, 82 in the Thymoglobulin arm and 81 in the Atgam arm.Methods: Estimates of the cost of care from the initiation of rejection therapy to 90 days post-therapy were derived from various publicly available sources and applied to patient-specific clinical events documented in the clinical trial. Patients received either intravenous Thymoglobulin (1.5 mg/kg/day) for an average of 10 days or intravenous Atgam (15 mg/kg/day) for an average of 9.7 days.Results: On average, Thymoglobulin provided significant cost savings compared with Atgam from the perspective of society [$US5977 (1996 values); 95% confidence interval (CI) $US3719 to $US8254], Medicare ($US4967; 95% CI $US3256 to $US6678) and the transplant centre ($US3087; 95% CI $US1512 to $US4667). The overall advantage attributable to Thymoglobulin was primarily due to savings from fewer recurrent rejection treatments and less frequent return to dialysis.Conclusions: Treatment of acute renal transplant rejection with Thymoglobulin is a cost saving strategy when compared with treatment with Atgam. [ABSTRACT FROM AUTHOR]

Reports that cytomegalovirus immune globulin intravenous administration modulates immune response to alloantigens in sensitized renal transplant candidates. Ability of hyperimmune anticytomegalovirus immunoglobulin preparation to affect in vitro and in vivo alloreactivity; Influence on cytotoxic lymphocyte activity.

Abstract The present study compares the relative costs of stocking ponds with postlarvae from wild or domesticated Kuruma shrimp, Penaeus japonicus (Bate), broodstock. Wild broodstock were obtained from a commercial trawler. Domesticated broodstock were reared to harvest size (wet weight = 25 g) on a commercial farm and then transferred to controlled environment tanks where they were grown to a final wet weight of 50 g. The costs of stocking ponds with postlarvae were calculated from the observed reproductive output, the costs of purchasing wild broodstock and the costs of domesticated broodstock production in the controlled environment facility. Domesticated P. japonicus spawned comparable numbers of eggs to wild broodstock of similar size, but hatching success was significantly lower. A total of 12 domesticated P. japonicus broodstock would be needed to produce the postlarvae to stock a 1-ha pond, compared to only six wild broodstock. However, the much higher relative costs of wild broodstock means that the cost of using their postlarvae would be Aus$851 per pond compared to Aus$390 for domesticated broodstock. The present authors conclude that the use of domesticated P. japonicus broodstock could be a cost-effective alternative to wild broodstock in Australia and in other countries where P. japonicus is farmed. [ABSTRACT FROM AUTHOR]

Objective: This model introduces a unique and inexpensive technique to estimate profit increases that might be expected from: (i) an additional clinical trial to establish a drug's second clinical indication; and (ii) a survey of market demand.Design: Microsoft Excel spreadsheets are used to solicit selected expert opinions about the new product's annual market share under scenarios reflecting different pricing points, promotional expenditures and clinical advantage.Main Outcome Measures and Results: The preprogrammed model returns profit-maximising price, promotional expenditure and market differentiation for each expert and the group as a whole. The extent of disagreement among the experts is used to estimate the additional profits which might be expected from a clinical trial and a market survey. Results from an illustrative application indicated greater incremental profits could be expected from the survey of market demand. The clinical trial generated smaller expected incremental profits because several experts felt that the trial's potential results would not affect the drug's profit-maximising price.Conclusions: With a 1-day meeting between 6 experts, the model provided a recommendation about the new product's profit-maximising market price and promotional expenditure. Furthermore, it estimated profit increases that might be expected from additional clinical trials and a survey of market demand. [ABSTRACT FROM AUTHOR]