Preventing acute rejection, Epstein-Barr virus infection, and posttransplant lymphoproliferative disorders after kidney transplantation: use of aciclovir and mycophenolate mofetil in a steroid-free immunosuppressive protocol
| Autor: | S A, Birkeland, H K, Andersen, S J, Hamilton-Dutoit |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Graft Rejection Male Herpesvirus 4 Human Adolescent Incidence Acyclovir Herpesviridae Infections Middle Aged Mycophenolic Acid Antiviral Agents Kidney Transplantation Lymphoproliferative Disorders Acute Disease Humans Female Prospective Studies Child Immunosuppressive Agents Antilymphocyte Serum Muromonab-CD3 Retrospective Studies |
| Zdroj: | Transplantation. 67(9) |
| ISSN: | 0041-1337 |
| Popis: | A widely held view is that any increase in the potency of an immunosuppressive agent will lead to an increase in infection and malignancy, such as life-threatening Epstein-Barr virus (EBV) induced posttransplant lymphoproliferative disorders (PTLD). We tested this paradigm by studying the effect of adding mofetil to a steroid-free protocol under cover of high-dose aciclovir prophylaxis on the number of acute rejections, EBV infections and PTLDs after kidney transplantation.EBV serology was performed in 267 consecutive renal transplantations (1990-1997). All were treated with cyclosporine with an initial 10-day antilymphocyte globulin course, supplemented from September 1995 with MMF. In 208 consecutive transplantations after June 1992 aciclovir 3200 mg/day was given for 3 months posttransplantation.After an observation period of up to 7 years we found that: (1) primary or reactivated EBV infection (PREBV) was correlated to acute rejection (treated with OKT3; P0.00005) and to the incidence of PTLD (P=0.03; P=0.01, if Hodgkin's disease is included); (2) aciclovir protected against PREBV (P0.00005) and (3) adding mofetil to the immunosuppressive protocol reduced PREBV further (P=0.0001), (4) in 78 transplantations treated with cyclosporine/antilymphocyte globulin/mofetil we observed only 10 acute rejections (P=0.0001), 10 PREBVs (P0.00005), and no PTLDs compared with the cyclosporine/antilymphocyte globulin group (P=0.04).Supplemental immunosuppression with mofetil protects against acute rejection. In combination with aciclovir, there is also a reduction in the number of PREBVs, apparently as a result of both direct viral prophylaxis and better rejection control, and in the incidence of EBV-induced PTLD. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|