Journal ArticleDOI
A comparison of tacrolimus (FK506) and cyclosporine for immunosuppression after cadaveric renal transplantation. FK506 Kidney Transplant Study Group
TLDR
Tacrolimus is more effective than cyclosporine in preventing acute rejection in cadaveric renal allograft recipients, and significantly reduces the use of antilymphocyte antibody preparations.Abstract:
Background. Tacrolimus (FK506), a macrolide molecule that potently inhibits the expression of interleukin 2 by T lymphocytes, represents a potential major advance in the management of rejection following solid-organ transplantation. This randomized, open-label study compared the efficacy and safety of tacrolimus-based versus cyclosporine-based immunosuppression in patients receiving cadaveric kidney transplants. Methods. A total of 412 patients were randomized to tacrolimus (n=205) or cyclosporine (n=207) after cadaveric renal transplantation and were followed for 1 year for patient and graft survival and the incidence of acute rejection. Results. One-year patient survival rates were 95.6% for tacrolimus and 96.6% for cyclosporine (P=0.576). Corresponding 1-year graft survival rates were 91.2% and 87.9% (P=0.289). There was a significant reduction in the incidence of biopsy-confirmed acute rejection in the tacrolimus group (30.7%) compared with the cyclosporine group (46.4%, P=0.001), which was confirmed by blinded review, and in the use of antilymphocyte therapy for rejection (10.7% and 25.1%, respectively; P<0.001). Impaired renal function, gastrointestinal disorders, and neurological complications were commonly reported in both treatment groups, but tremor and paresthesia were more frequent in the tacrolimus group. The incidence of posttransplant diabetes mellitus was 19.9% in the tacrolimus group and 4.0% in the cyclosporine group (P<0.001), and was reversible in some patients. Conclusions. Tacrolimus is more effective than cyclosporine in preventing acute rejection in cadaveric renal allograft recipients, and significantly reduces the use of antilymphocyte antibody preparations. Tacrolimus was associated with a higher incidence of neurologic events, which were rarely treatment limiting, and with posttransplant diabetes mellitus, which was reversible in some patients.read more
Citations
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A systematic review of the literature
Arindam Basu,Pamela Smartt +1 more
TL;DR: Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients and Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients.
Journal ArticleDOI
Improved Graft Survival after Renal Transplantation in the United States, 1988 to 1996
Sundaram Hariharan,Christopher P. Johnson,Barbara A. Bresnahan,S. Taranto,Matthew McIntosh,Donald Stablein +5 more
TL;DR: There has been a substantial increase in short-term and long-term survival of kidney grafts from both living and cadaveric donors since 1988.
Journal ArticleDOI
Diabetes Mellitus after Kidney Transplantation in the United States
TL;DR: High incidences of PTDM are associated with the type of initial maintenance immunosuppression, race, ethnicity, obesity and hepatitis C infection, and it is a strong, independent predictor of graft failure and mortality.
Journal ArticleDOI
Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report
Gerhard Opelz,Bernd Döhler +1 more
TL;DR: The continuing risk for lymphoma with time post‐transplantation, the contribution of immunosuppression to increased risk, and continuing poor outcomes in patients with post-transplant lymphoma are highlighted.
Journal ArticleDOI
Efficacy of sirolimus compared with azathioprine for reduction of acute renal allograft rejection: a randomised multicentre study
TL;DR: Use of sirolimus reduced occurrence and severity of biopsy-confirmed acute rejection episodes with no increase in complications and further studies are needed to establish the optimum doses for the combined regimen.
References
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Journal ArticleDOI
International standardization of criteria for the histologic diagnosis of renal allograft rejection : the Banff working classification of kidney transplant pathology
Kim Solez,Roy A. Axelsen,Hallgrimur Benediktsson,James F. Burdick,Arthur H. Cohen,Robert B. Colvin,Byron P. Croker,Dominique Droz,Michael S. Dunnill,Philip F. Halloran,Pekka Häyry,J. Charles Jennette,Paul Keown,Niels Marcussen,Michael J. Mihatsch,Kunio Morozumi,Bryan D. Myers,Cynthia C. Nast,Steen Olsen,Lorraine C. Racusen,E L Ramos,Seymour Rosen,David H. Sachs,Daniel R. Salomon,Fred Sanfilippo,Regina R. Verani,Eeva von Willebrand,Yutaka Yamaguchi +27 more
TL;DR: A schema for international standardization of nomenclature and criteria for the histologic diagnosis of renal allograft rejection was developed in Banff, Canada on August 2-4, 1991 and validated by the circulation of sets of slides for scoring by participant pathologists.
Journal ArticleDOI
Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. U.S. Renal Transplant Mycophenolate Mofetil Study Group.
TL;DR: This study demonstrated that MMF administered at a dosage of 2 g or 3 g daily, in combination with maintenance CsA and corticosteroids as triple therapy following ATGAM® induction therapy, is more effective than an otherwise identical regimen that includes azathioprine instead of MMF in preventing acute allograft rejection in first cadaveric renal transplant patients.
Journal ArticleDOI
Early versus late acute renal allograft rejection: impact on chronic rejection.
Giacomo Basadonna,Arthur J. Matas,Kristen J. Gillingham,William D. Payne,David L. Dunn,D. E. R. Sutherland,P. F. Gores,Rainer W.G. Gruessner,J. S. Najarian +8 more
TL;DR: It is concluded that acute rejection is strongly related to the development of biopsy-proven chronic rejection and subsequent graft loss and patients undergoing their first acute rejection episode > 60 days have an increased incidence of chronic rejection.
Acute rejection episodes: best predictor of long-term primary cadaveric renal transplant survival.
Raymond J. Tesi,Elmahdi A. Elkhammas,Mitchell L. Henry,Elizabeth A. Davies,A. Salazar,Ronald M. Ferguson +5 more
TL;DR: In this article, a multivariate analysis was performed using age, sex, blood type, race, presence of diabetes, HLA mismatch, current and maximum panel reactive antibody (PRA), time to first rejection episode, treatment of first rejection episodes, and number of rejection episodes (none, one, or more than one).
Journal Article
Acute rejection episodes--best predictor of long-term primary cadaveric renal transplant survival.
TL;DR: Number of rejection episodes was by far the most important co-variate and occurrence of acute rejection did not correlate with the degree of HLA mismatch or PRA, and demographic and immunologic variables were similar for all three groups.
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