Journal ArticleDOI
Mycophenolate mofetil reduces late renal allograft loss independent of acute rejection.
Akinlolu O. Ojo,Herwig Ulf Meier-Kriesche,Julie A. Hanson,Alan B. Leichtman,Diane M. Cibrik,John C. Magee,Robert A. Wolfe,Lawrence Y. Agodoa,Bruce Kaplan +8 more
TLDR
Mycophenolate Mofetil therapy decreased the relative risk for development of chronic allograft failure (CAF) by 27% and was independent of its outcome on acute rejection.Abstract:
Background. Mycophenolate Mofetil (MMF) has been shown to significantly decrease the number of acute rejection episodes in renal transplant recipients during the 1st year. A beneficial effect of MMF on long-term graft survival has been more difficult to demonstrate. This beneficial effect has not been detected, despite the impact of acute rejection on the development of chronic allograft nephropathy and experimental evidence that MMF may have a salutary effect on chronic allograft nephropathy independent of that of rejection. Methods. Data on 66,774 renal transplant recipients from the U.S. renal transplant scientific registry were analyzed. Patients who received a solitary renal transplant between October 1, 1988 and June 30, 1997 were studied. The Cox proportional hazard regression was used to estimate relevant risk factors. Kaplan-Meier analysis was performed for censored graft survival. Results. MMF decreased the relative risk for development of chronic allograft failure (CAF) by 27% (risk ratio [RR] 0.73, P<0.001). This effect was independent of its outcome on acute rejection. Censored graft survival using MMF versus azathioprine was significantly improved by Kaplan-Meier analysis at 4 years (85.6% v. 81.9%). The effect of an acute rejection episode on the risk of developing CAF seems to be increasing over time (RR51.9, 1988 ‐91; RR52.9, 1992‐94; RR53.7, 1995‐ 97). Conclusion. MMF therapy decreases the risk of developing CAF. This improvement is only partly caused by the decrease in the incidence of acute rejection observed with MMF; but, is also caused by an effect independent of acute rejection.read more
Citations
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Journal ArticleDOI
Strategies to improve long-term outcomes after renal transplantation.
TL;DR: Current antirejection therapy, including calcineurin blockers such as cyclosporine and tacrolimus, the interleukin-2 signal-transduction inhibitor sirolimus and the purine-synthesis inhibitor mycophenolate mofetil are discussed, which inhibits the proliferation of T cells and B cells.
Journal ArticleDOI
Immunosuppressive agents in solid organ transplantation: Mechanisms of action and therapeutic efficacy.
TL;DR: An overview of the different immunosuppressive agents currently used in solid organ transplantation is provided and many of the key clinical trials that underpin current clinical usage of these agents are described and side-effects are highlighted.
Journal ArticleDOI
Mechanisms of action of mycophenolate mofetil in preventing acute and chronic allograft rejection.
TL;DR: Mycophenolate mofetil (MMF), a prodrug of mycophenolic acid (MPA), an inhibitor of inosine-5'-monophosphate dehydrogenase, has several immunosuppressant actions and may prevent chronic rejection by several mechanisms.
Journal ArticleDOI
Therapeutic drug monitoring of mycophenolate mofetil in transplantation.
Teun van Gelder,Yann Le Meur,Leslie M. Shaw,Michael Oellerich,David DeNofrio,Curtis Holt,David W. Holt,Bruce Kaplan,Dirk Kuypers,Bruno Meiser,Burkhard Toenshoff,Richard D. Mamelok +11 more
TL;DR: A roundtable meeting to discuss the use of therapeutic drug monitoring (TDM) to guide immunosuppression with mycophenolate mofetil was held in New York in December 2004, and it was agreed that TDM might help optimize outcomes, especially in patients at higher risk of rejection.
Journal ArticleDOI
Calcineurin inhibitor-sparing regimens in solid organ transplantation: focus on improving renal function and nephrotoxicity.
TL;DR: This work sought to review the impact of CNI‐sparing strategies in kidney, liver, and heart transplantation and found strategies to limit CNI exposure include CNI minimization, avoidance, and withdrawal.
References
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Journal Article
Placebo-controlled study of mycophenolate mofetil combined with cyclosporine and corticosteroids for prevention of acute rejection
Josep M. Grinyó,Carl-Gustav Groth,Rudolf Pichlmayr,Sa Sadek,Yves Vanrenterghem,M Behrend,R Luck,Francesc Moreso,J Peeters,J Rodicio,J Morales,Dagfinn Albrechtsen,P Fauchald,Sameh S. Sadek,J. P. A. Lodge,Jp Soulillou,Diego Cantarovich,van Willem Son,Adam Tegzess,Karl-Heinz Wagner,J Erhard,Christina Brattström,Lars Mjörnstedt,M. Wiesel,S. Carl,Hh Neumayer,Hauser,Peter Lang,B Bourgeon,Gunnar Tufveson,G. Gannedahl,Henrik Ekberg,N. Persson,A Tarantino,M Campise,G Thiel,M Zeiler,R Hene,G Ligtenberg,A Morgan,K Rigg,Hooftman L,K Hutchinson +42 more
TL;DR: MMF significantly reduced the rate of biopsy-proven rejection or other treatment failure during the first 6 months after transplantation and was well tolerated, although the 3 g dose was somewhat less well tolerated.
Journal ArticleDOI
A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation
Paul Keown,Pekka Häyry,Peter J. Morris,Calvin R. Stiller,Christopher M. Barker,Lisa Carr,David Landsberg,Ian R. Hardie,Russell J. Rigby,Helena Isoniemi,Derek W. R. Gray,Philip Belitsky,Allan McDonald,Tim Mathew,A. Clarkson,L. Barratt,B. Buchholz,Rowan Walker,Günther Kirste,Norman Muirhead,David J. Tiller,Geoff Duggin,Philip F. Halloran,Pierre Daloze,Gilles St. Louis,David Russell,David Ludwin,P. Vialtel,U. Binswanger,J. A C Buckels,Jean Louis Touraine,David P. Hickey,Giuseppe Remuzzi,Giuseppe Locatelli,F. T. Lam,Ed Tapper +35 more
TL;DR: MMF is associated with a significantly lower rate of treatment failure compared with AZA during the first 6 months after renal transplantation and produces a clinically important reduction in the incidence, severity, and treatment of acute graft rejection.
Journal ArticleDOI
Sirolimus (rapamycin)-based therapy in human renal transplantation: similar efficacy and different toxicity compared with cyclosporine. Sirolimus European Renal Transplant Study Group.
Carl G. Groth,Lars Bäckman,José-Maria Morales,Roy Y. Calne,Henri Kreis,Philippe Lang,Jean-Louis Touraine,Kerstin Claesson,Josep M. Campistol,Dominique Durand,L. Wramner,Christina Brattström,Bernard Charpentier +12 more
TL;DR: Sirolimus (rapamycin) is a potent immunosuppressant with a mechanism of action different from cyclosporine (CsA) or tacrolimus as discussed by the authors.
Journal ArticleDOI
Interleukin-2–Receptor Blockade with Daclizumab to Prevent Acute Rejection in Renal Transplantation
Flavio Vincenti,Robert L. Kirkman,Susan Light,Ginny L. Bumgardner,Mark D. Pescovitz,Philip F. Halloran,J. Neylan,Alan H. Wilkinson,Henrik Ekberg,Robert S. Gaston,Lars Bäckman,James F. Burdick +11 more
TL;DR: Daclizumab is a genetically engineered human IgG1 monoclonal antibody that binds specifically to the α chain of the interleukin-2 receptor and may thus reduce the risk of rejection after renal transplantation.
Journal ArticleDOI
Randomised trial of basiliximab versus placebo for control of acute cellular rejection in renal allograft recipients
TL;DR: Prophylaxis with 40 mg basiliximab reduces the incidence of acute rejection episodes significantly, with no clinically relevant safety or tolerability concerns.
Related Papers (5)
Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. U.S. Renal Transplant Mycophenolate Mofetil Study Group.
A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation
Paul Keown,Pekka Häyry,Peter J. Morris,Calvin R. Stiller,Christopher M. Barker,Lisa Carr,David Landsberg,Ian R. Hardie,Russell J. Rigby,Helena Isoniemi,Derek W. R. Gray,Philip Belitsky,Allan McDonald,Tim Mathew,A. Clarkson,L. Barratt,B. Buchholz,Rowan Walker,Günther Kirste,Norman Muirhead,David J. Tiller,Geoff Duggin,Philip F. Halloran,Pierre Daloze,Gilles St. Louis,David Russell,David Ludwin,P. Vialtel,U. Binswanger,J. A C Buckels,Jean Louis Touraine,David P. Hickey,Giuseppe Remuzzi,Giuseppe Locatelli,F. T. Lam,Ed Tapper +35 more
Placebo-controlled study of mycophenolate mofetil combined with cyclosporine and corticosteroids for prevention of acute rejection
Josep M. Grinyó,Carl-Gustav Groth,Rudolf Pichlmayr,Sa Sadek,Yves Vanrenterghem,M Behrend,R Luck,Francesc Moreso,J Peeters,J Rodicio,J Morales,Dagfinn Albrechtsen,P Fauchald,Sameh S. Sadek,J. P. A. Lodge,Jp Soulillou,Diego Cantarovich,van Willem Son,Adam Tegzess,Karl-Heinz Wagner,J Erhard,Christina Brattström,Lars Mjörnstedt,M. Wiesel,S. Carl,Hh Neumayer,Hauser,Peter Lang,B Bourgeon,Gunnar Tufveson,G. Gannedahl,Henrik Ekberg,N. Persson,A Tarantino,M Campise,G Thiel,M Zeiler,R Hene,G Ligtenberg,A Morgan,K Rigg,Hooftman L,K Hutchinson +42 more