Eight-year outcomes of 'the Cairo Kidney Centre sequential protocol'.
| Autor: | Fayad T; From the Department of Internal Medicine, Cairo University; and the Cairo Kidney Centre, Cairo, Egypt., William E, Tawfik N, Habashy B, Abou-Youssef HS, Shokry S, Khalil S, Morsy A, Barsoum R |
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| Jazyk: | angličtina |
| Zdroj: | Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation [Exp Clin Transplant] 2015 Apr; Vol. 13 Suppl 1, pp. 23-9. |
| Abstrakt: | Objectives: To describe the long-term results of a previously developed a sirolimus-based sequential immunosuppression protocol for kidney transplant comprising 2 phases: sirolimus + cyclosporine + prednisolone for 3 months followed by sirolimus + prednisolone + mycophenolate mofetil with steroid minimization the first year. Two-year outcomes of patients on this protocol (group A) showed equivalent patient and graft survival, yet with significantly better function, compared with those on cyclosporine + mycophenolate mofetil + prednisolone (group B). Materials and Methods: We report the 8-year outcomes in the same cohort (76 patients in group A and 37 in group B). Results: 42% switched from group A to B versus 43% switching from B to A. Intent-to-treat patient survivals at 5 and 8 years were 88% and 85.5% for group A, and 78% and 73% for group B. Death-censored graft survivals were 93% for group A and 95% for group B. Graft function was significantly better at 8 years, with 91% of group A patients compared with 50% in group B having estimated glomerular filtration rates > 45 mL/min/1.73 m2, and a significantly lower incidence of chronic allograft nephropathy in the former. Secondary parameters including blood pressure control, new onset diabetes mellitus, proteinuria and other drug-related adverse events showed no significant differences between the groups. Conclusions: The sirolimus-based sequential immunosuppression protocol was well tolerated in 58% of patients. The intent-to-treat and patients-ontherapy analyses revealed that it was equivalent to the widely used cyclosporine + mycophenolate mofetil + prednisolone protocol regarding patient and graft survival. It is associated with better graft function and lower incidence of chronic allograft nephropathy in 8 years' follow-up. The incidence of drug-related adverse reactions was not statistically different from those in the comparator. |
| Databáze: | MEDLINE |
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