Long-term benefits with sirolimus-based therapy after early cyclosporine withdrawal
| Autor: | Pierre Daloze, Martine Gioud-Paquet, Rainer Oberbauer, James T. Burke, John F. Neylan, Joseph Scarola, Henri Kreis, Josep M. Campistol, Yves Brault, Francesco Paolo Schena, Timothy H. Mathew |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Nephrology
Graft Rejection medicine.medical_specialty Time Factors Hyperkalemia Urology Renal function Internal medicine Medicine Humans Survival rate Sirolimus business.industry Graft Survival General Medicine Kidney Transplantation Hypokalemia Surgery Transplantation Survival Rate Regimen Acute Disease Cyclosporine Abnormal Liver Function Test medicine.symptom business Immunosuppressive Agents |
| Zdroj: | Journal of the American Society of Nephrology : JASN. 15(3) |
| ISSN: | 1046-6673 |
| Popis: | Graft function at 6 or 12 mo is positively correlated with renal transplant survival. The 36-mo results of a study that tested whether withdrawing cyclosporine (CsA) from a sirolimus (SRL)-CsA-steroid (ST) regimen would affect renal graft survival are reported. Eligible patients (n = 430) who were receiving SRL-CsA-ST were randomly assigned at 3 mo to remain on SRL-CsA-ST or to have CsA withdrawn (SRL-ST group). At 36 mo, the calculated GFR was significantly better with SRL-ST (47.3 versus 59.4 ml/min; P < 0.001) as was the slope of the GFR (-3.6 versus 0.8 ml/min; P < 0.001). This was accompanied by growing trend for improved graft survival in the SRL-ST group (85.1% versus 91.2%, P = 0.052 at 36 mo; 81.4% versus 91.2%, P = 0.015 in a cumulative data analysis up to 54 mo), despite numerically more biopsy-proven acute rejections after randomization (5.6% versus 10.2%; P = 0.107). Lipid parameters were similar between groups, whereas both systolic and diastolic BP were significantly lower in the SRL-ST group. Investigator-reported hypertension, abnormal kidney function, edema, hyperuricemia, hyperkalemia, gingival hyperplasia, and Herpes zoster occurred significantly more often in SRL-CsA-ST patients. Abnormal liver function test results, hypokalemia, thrombocytopenia, and abnormal healing were reported significantly more often with SRL-ST. The discontinuation rate was significantly higher for SRL-CsA-ST (48% versus 38%; P = 0.041). In conclusion, withdrawing CsA from a SRL-CsA-ST regimen at 3 mo after transplantation resulted in long-term benefits for renal transplant recipients. |
| Databáze: | OpenAIRE |
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