Efficacy and safety of early cyclosporine conversion to sirolimus with continued MMF-four-year results of the Postconcept study

Autor: Isabelle Etienne, Pierre-François Westeel, Thierry Frouget, Yvon Lebranchu, B. Hurault de Ligny, Jean-Philippe Rerolle, Etienne Thervet, Antoine Thierry, Sandrine Girardot-Seguin, Bruno Moulin, Olivier Toupance, Mathias Büchler
Přispěvatelé: Service de néphrologie et immunologie clinique [CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT), Service de néphrologie - hémodialyse et transplantation rénale, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de néphrologie adultes [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Néphrologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de dyalise et transplantation, Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), service de néphrologie et transplantation, CHU Strasbourg, Service de Néphrologie, Dialyse, Transplantations [CHU Limoges], CHU Limoges, Service de néphrologie [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Roche SAS, Centre Hospitalier Universitaire de Reims (CHU Reims), Marquet, Pierre, Service de néphrologie et immunologie clinique, Université de Tours-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service de néphrologie, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Université de Tours, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Université de Tours-CHRU Tours, Université de Poitiers-Centre hospitalier universitaire de Poitiers ( CHU Poitiers ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Université de Picardie Jules Verne ( UPJV ) -CHU Amiens-Picardie, service de néphrologie et transplantation rénale, CHU Caen, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Reims ( CHU Reims )
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Male
030232 urology & nephrology
030230 surgery
Kidney Function Tests
urologic and male genital diseases
MESH: Cyclosporine
MESH: Kidney Transplantation
0302 clinical medicine
Chronic allograft nephropathy
Immunology and Allergy
Medicine
MESH : Female
Pharmacology (medical)
MESH : Immunosuppressive Agents
MESH : Graft Survival
education.field_of_study
Proteinuria
MESH: Middle Aged
Graft Survival
Middle Aged
MESH : Adult
[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences
MESH : Survival Rate
3. Good health
Survival Rate
[SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences
MESH: Kidney Failure
Chronic
MESH: Kidney Function Tests
Cyclosporine
Female
MESH: Immunosuppressive Agents
medicine.symptom
Immunosuppressive Agents
medicine.drug
Adult
medicine.medical_specialty
MESH: Survival Rate
MESH: Graft Survival
MESH : Male
Population
Urology
Renal function
MESH : Kidney Failure
Chronic
Nephrotoxicity
03 medical and health sciences
MESH : Cyclosporine
Humans
MESH : Middle Aged
education
Sirolimus
Transplantation
MESH: Humans
business.industry
MESH : Sirolimus
MESH : Humans
MESH : Kidney Function Tests
MESH: Adult
medicine.disease
Kidney Transplantation
MESH: Male
Surgery
Calcineurin
[ SDV.SP ] Life Sciences [q-bio]/Pharmaceutical sciences
Kidney Failure
Chronic
MESH : Kidney Transplantation
MESH: Sirolimus
business
MESH: Female
Zdroj: American Journal of Transplantation
American Journal of Transplantation, 2011, 11 (8), pp.1665-75. ⟨10.1111/j.1600-6143.2011.03637.x⟩
American Journal of Transplantation, Wiley, 2011, 11 (8), pp.1665-75. ⟨10.1111/j.1600-6143.2011.03637.x⟩
American Journal of Transplantation, Wiley, 2011, 11 (8), pp.1665-75. 〈10.1111/j.1600-6143.2011.03637.x〉
ISSN: 1600-6135
1600-6143
DOI: 10.1111/j.1600-6143.2011.03637.x⟩
Popis: International audience; Calcineurin inhibitor (CNI) withdrawal has been used as a strategy to improve renal allograft function. We previously reported that conversion from cyclosporine A (CsA) to sirolimus (SRL) 3 months after transplantation significantly improved renal function at 1 year. In the Postconcept trial, 77 patients in the SRL group and 85 in the CsA group were followed for 48 months. Renal function (Cockcroft and Gault) was significantly better at month 48 (M48) in the SRL group both in the intent-to-treat population (ITT): 62.6 mL/min/1.73 m(2) versus 57.1 mL/min/1.73 m(2) (p = 0.013) and in the on-treatment population (OT): 67.5 mL/min/1.73 m(2) versus 57.4 mL/min/1.73 m(2) (p = 0.002). Two biopsy proven acute rejection episodes occurred after M12 in each group. Graft and patient survival were comparable (graft survival: 97.4 vs. 100%; patient survival: 97.4 vs. 97.6%, respectively). The incidence of new-onset diabetes was numerically increased in the SRL group (7 vs. 2). In OT, three cancers occurred in the SRL group versus nine in the CsA group and mean proteinuria was increased in the SRL group (0.42 ± 0.44 vs. 0.26 ± 0.37; p = 0.018). In summary, the renal benefits associated with conversion of CsA to SRL, at 3 months posttransplantation, in combination with MMF were maintained for 4 years posttransplantation.
Databáze: OpenAIRE
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