| Revista: | Brazilian journal of medical and biological research |
| Base de datos: | PERIÓDICA |
| Número de sistema: | 000349878 |
| ISSN: | 0100-879X |
| Autores: | Garcia, R1 Machado, P.G1 Felipe, C.R1 Park, S.I1 Spinelli, G.A1 Franco, M.F2 Tedesco Silva-Junior, H1 Medina-Pestana, J.O1 |
| Instituciones: | 1Universidade Federal de Sao Paulo, Hospital do Rim e Hipertensao, Sao Paulo. Brasil 2Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Sao Paulo. Brasil |
| Año: | 2007 |
| Periodo: | Abr |
| Volumen: | 40 |
| Número: | 4 |
| Paginación: | 457-465 |
| País: | Brasil |
| Idioma: | Inglés |
| Tipo de documento: | Artículo |
| Enfoque: | Experimental, aplicado |
| Resumen en inglés | Chronic allograft nephropathy is among the major causes of graft loss even in low-risk kidney transplant recipients and correlates with acute nephrotoxic events during the first year post-transplant. Therefore, calcineurin inhibitor-free regimens may improve patient and graft survival among recipients of living-related kidney transplants. To confirm this hypothesis, we evaluated the efficacy and safety of two calcineurin inhibitor-free regimens in 92 low-risk recipients of one-haplotype living-related kidney transplants. Immunosuppression consisted of tacrolimus, azathioprine and prednisone (group I, GI, N = 38), 2 doses of daclizumab, mycophenolate mofetil (MMF), and prednisone (GII, N = 33) and 2 doses of daclizumab, MMF, sirolimus and prednisone (GIII, N = 21). At 12 months, treatment failure (biopsy-confirmed acute rejection, graft loss or death) was higher in GII compared to GIII and GI (54.5 vs 24.0 vs 13.1%, P < 0.01, respectively). In patients of black ethnicity the incidence of acute rejection was 25 vs 83.3 vs 20% (P = 0.055), respectively. Patient and graft survival was comparable. There were no differences in mean creatinine or calculated creatinine clearance at 12 months. Overall incidence of post-transplant diabetes mellitus (3.3%) and cytomegalovirus disease (4.3%) was similar in all groups. Further development of effective calcineurin inhibitor-free regimens should exclude patients of black ethnicity and may need full-induction therapy, perhaps with depleting agents, and concentration-controlled use of sirolimus and MMF |
| Disciplinas: | Medicina |
| Palabras clave: | Cirugía, Nefrología, Inmunología, Riñones, Trasplante, Rechazo agudo, Tacrolimus, Sirolimus, Micofenolato de mofetilo, Ensayos clínicos |
| Keyword: | Medicine, Nephrology, Surgery, Immunology, Kidneys, Transplantation, Acute rejection, Tacrolimus, Sirolimus, Mycophenolate mofetil, Clinical trials |
| Texto completo: | Texto completo (Ver HTML) |
