One-year glomerular filtration rate predicts graft survival in pediatric renal recipients: a randomized trial of tacrolimus vs cyclosporine microemulsion
| Autor: | Guido Filler, J. Janda, G. Zacchello, B. Klare, Ryszard Grenda, M. McGraw, D. V. Milford, S. Friman, D. Hughes, E. Balzar, R. Trompeter, G. Offner, N. J A Webb, L. Ghio, Ferenc Perner, I. B. Brekke, J. Stolpe, G. Tyden, A. R. Watson, R. Gusmano |
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| Rok vydání: | 2002 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Adolescent Population Urology chemical and pharmacologic phenomena Azathioprine Lower risk Tacrolimus Predictive Value of Tests medicine Humans education Child Kidney transplantation Transplantation education.field_of_study business.industry Graft Survival Ciclosporin medicine.disease Kidney Transplantation Surgery Calcineurin surgical procedures operative Treatment Outcome Cyclosporine Emulsions Female business Immunosuppressive Agents medicine.drug Follow-Up Studies Glomerular Filtration Rate |
| Zdroj: | Transplantation proceedings. 34(5) |
| ISSN: | 0041-1345 |
| Popis: | CALCINEURIN INHIBITORS (tacrolimus and cyclosporine) remain the principle immunosuppressants prescribed in renal transplantation. Large-scale, randomised, multicentre trials in adult renal transplant recipients that compared the clinical efficacy and safety of tacrolimus and the standard formulation of cyclosporine, combined with azathioprine and corticosteroids as adjunctive therapies, showed that acute allograft rejection was significantly reduced with tacrolimus-based therapy. The benefits of tacrolimus in these studies, which used higher tacrolimus levels than most centres would currently aim for, were offset by a higher incidence of side effects, particularly diabetes. When using lower target tacrolimus levels, there appears to be a lower acute rejection rate in comparison to a microemulsified cyclosporine-based protocol. A recent metaanalysis of all randomized trials comparing tacrolimus and cyclosporine in kidney transplantation confirmed the lower risk of rejection with tacrolimus therapy in adult patients. However, lower rejection rates do not necessarily yield better graft survival. Tacrolimus is becoming increasingly utilized in pediatric renal transplant recipients, a population in which it is particularly important to achieve optimal graft function and long-term graft survival. We recently undertook a 6-month multicentre randomised trial with an open extension phase with a prospective long-term follow-up over 5 years. Rejection rates were significantly lower in the tacrolimus arm, with a difference of glomerular filtration rate (GFR) as early as 6 months, yet there was no difference in patient and graft survival at 6 and 12 months. This paper describes the 2-year follow-up data and analyzes the impact of GFR at 1 year on long-term graft survival. |
| Databáze: | OpenAIRE |
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