Exploratory calcineurin inhibitor-free regimens in living-related kidney transplant recipients



Título del documento: Exploratory calcineurin inhibitor-free regimens in living-related kidney transplant recipients
Revista: Brazilian journal of medical and biological research
Base de datos: PERIÓDICA
Número de sistema: 000349878
ISSN: 0100-879X
Autores: 1
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2
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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:
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
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