Abstract:
INTRODUCTION:Conversion from calcineurin inhibitor (CI)-based maintenance immunosuppression to sirolimus (SRL)-based immunosuppression may be beneficial in selected renal transplant recipients. The purpose of this study was to evaluate the safety and efficacy of a daclizumab (DAC) bridge protocol in patients converted from CI- to SRL-based maintenance immunosuppression. METHODS:We conducted a retrospective chart review of renal transplant recipients who were converted to SRL at least 2 months post-transplant. The protocol consisted of an abrupt discontinuation of either cyclosporin (CsA) or tacrolimus (TAC), initiation of SRL within 48 h of CI discontinuation, and DAC 2 mg/kg at the time of CI discontinuation and again at 14 d (depending on the SRL serum concentration). The SRL starting dose was based on risk stratification in each patient. RESULTS:Twenty-one renal transplant patients were converted to SRL (11 from TAC, 10 from CsA) between October 2001 and July 2003. Conversion occurred at a mean of 23 months post-transplant. Indications for SRL conversion included 12 for chronic allograft nephropathy (CAN), four for CI-associated neurotoxicity, two for thrombotic microangiopathy (TMA), two for post-transplant diabetes mellitus (PTDM), and one for polyomavirus interstitial nephritis (PVN). Mean follow-up was 16 months from time of conversion. Therapeutic SRL levels were reached at a mean of 14 d. Total serum cholesterol levels increased from a mean of 205 (+/- 47) to 234 (+/- 55) mg/dL (P = 0.014), and serum triglyceride levels increased from a mean of 186 (+/- 66) to 257 (+/- 88) mg/dL (P = 0.002). In addition, mean haemoglobin level decreased from 12.0 (+/- 2.3) to 10.5 (+/- 2.1) g/dL (P = 0.002); total white blood cell count decreased from 8300 (+/- 4300) to 4700 (+/- 1400)/mm(3) (P < 0.001); and platelet count decreased from 238 000 (+/- 72 800) to 186 000 (+/- 51 900)/mm(3) (P = 0.002) from before to after conversion. Patients experienced the following side-effects while taking SRL: diarrhoea (n = 6), peripheral oedema (n = 5), arthralgias (n = 4), anaemia (n = 4), oral ulcers (n = 1), deep vein thrombosis (n = 1), shortness of breath (n = 1), and mild increase in serum transaminases (n = 1). Two patients (9.5%) discontinued SRL due to side-effects, both secondary to severe arthralgias. There were two serious infections noted after conversion: one Pseudomonas aeruginosa urosepsis, and one PVN (that was ongoing prior to conversion). Patient survival was 100%, and kidney graft survival was 76%. Five patients (24%) lost their allograft after conversion due to progression of CAN (n = 2), persistent TMA in the kidney (n = 1), patient self-discontinuation of sirolimus (n = 1), and preexisting PVN unresponsive to cidofovir therapy (n = 1). Of the five patients who lost their allograft, the mean serum creatinine at the time of conversion was 3.5 (+/-1.1) mg/dL compared with 2.2 (+/- 0.8) mg/dL in patients who did not lose their allograft (P = 0.034). No acute rejection episodes occurred after conversion to sirolimus. CONCLUSIONS:DAC bridge therapy provides safe and effective immunosuppressive coverage while converting renal transplant recipients from CI- to SRL-based maintenance immunosuppressive therapy. A pharmacoeconomic analysis, however, is necessary to determine the cost-effectiveness of this conversion protocol.
journal_name
Clin Transplantjournal_title
Clinical transplantationauthors
Sundberg AK,Rohr MS,Hartmann EL,Adams PL,Stratta RJdoi
10.1111/j.1399-0012.2004.00220.xsubject
Has Abstractpub_date
2004-01-01 00:00:00pages
61-6eissn
0902-0063issn
1399-0012pii
CTR220journal_volume
18 Suppl 12pub_type
杂志文章abstract:BACKGROUND AND OBJECTIVES:The risk of de novo donor-specific antibody (dnDSA) development following BK viremia (BKV) or nephropathy (BKN) after kidney transplant remains unclear. We aimed to evaluate the relationships among dnDSA, BKV (BK blood PCR > 15 000 copies), BKN, antibody-mediated rejection (AMR), and allograft...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.13194
更新日期:2018-03-01 00:00:00
abstract::The combination of methotrexate and cyclosporine A (MTX-CSA) is the standard regimen for the prevention of graft vs. host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-SCT) from HLA-identical siblings. Mycophenolate mofetil and CSA (MMF-CSA) combination has been successfully used for GV...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2008.00894.x
更新日期:2009-01-01 00:00:00
abstract::Retrograde arterial flush (RGAF) of liver grafts, which prevents arterial intima injuries in living donor liver transplantation (LDLT), seemed to reduce post-transplantational cholestasis by our preliminary study. The aim of this study was to further confirm this effect of RGAF of grafts in LDLT by a prospective rando...
journal_title:Clinical transplantation
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1399-0012.2011.01493.x
更新日期:2012-03-01 00:00:00
abstract::To define the etiology of anemia post-renal transplantation, we assessed hematologic parameters and EPO levels in 38 anemic and 16 non-anemic control renal transplant recipients (RTRs) with varying degrees of allograft function at periods > 3 months post-transplantation. Significant differences between the two groups ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:
更新日期:1997-08-01 00:00:00
abstract::Portal vein thrombosis (PVT), a common complication of end stage liver disease, is no longer considered a definite contraindication for liver transplantation (LTx). The clinical decision to perform an LTx in the case of PVT depends on the degree of PVT and the experience of the surgeon. Eversion thromboendovenectomy w...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:10.1111/j.1399-0012.2006.00560.x
更新日期:2006-09-01 00:00:00
abstract::It is unclear whether a concomitant kidney transplant grants survival benefit to liver transplant (LT) candidates with renal dysfunction (RD). We retrospectively studied LT candidates without RD (n = 714) and LT candidates with RD who underwent either liver transplant alone (RD-LTA; n = 103) or simultaneous liver-kidn...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12479
更新日期:2015-01-01 00:00:00
abstract:UNLABELLED:Since the first description by Ratner and collegues in 1996, laparoscopic live-donor nephrectomy is gaining wide acceptance in an attempt to minimize the donor morbidity, length of hospital stay and length of time to return to work. It is unknown whether multiple renal arteries pose additional problems with ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1034/j.1399-0012.2001.00012.x
更新日期:2001-01-01 00:00:00
abstract::We report an adult liver transplant recipient with parvovirus B19 infection, presenting as chronic transfusion-dependent anemia ensuing 1 month post-transplantation. Both serum and bone marrow cells were positive for parvovirus B19 DNA detected by polymerase chain reaction. The bone marrow biopsy revealed erythroid hy...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:
更新日期:1996-06-01 00:00:00
abstract::Porto-pulmonary hypertension with moderate or severe pulmonary arterial hypertension (PAH) is viewed as a contraindication to liver transplantation (LT) because of associated poor outcomes; however, patients with biliary atresia (BA) are generally good candidates for LT. Ten patients with moderate/severe PAH underwent...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12415
更新日期:2014-09-01 00:00:00
abstract::Cell-mediated responses to xenoantigens are different from those to alloantigens. CD4+ T cells are especially important in xenoresponses and depletion of CD4+ T cells can prolong survival of xenografts better than allografts in some circumstances. The difference between the two responses is due in part to the relative...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:
更新日期:1994-04-01 00:00:00
abstract:INTRODUCTION:The impact of induction immunosuppression on long-term survival in lung transplant recipients remains unclear. We sought to evaluate the effect of contemporary induction immunosuppression agents in lung transplant recipients' survival, utilizing national registry data. METHODS:We queried the United Networ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12339
更新日期:2014-04-01 00:00:00
abstract:INTRODUCTION:Totally implantable venous access devices (TIVADs) are the preferred devices for patients with advanced lung disease who require long-term venous access. The primary purpose of this study was to describe the natural history of TIVADs left in place at the time of transplant. METHODS:This multicenter retros...
journal_title:Clinical transplantation
pub_type: 杂志文章,多中心研究
doi:10.1111/ctr.13465
更新日期:2019-02-01 00:00:00
abstract::Of 1463 liver allograft recipients receiving the combination of FK506 and steroids as their primary immunosuppressive regimen, 2 patients developed Kaposi's sarcoma. Although previously described as a complication of organ transplantation, this is the first case report of Kaposi's sarcoma occurring in association with...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract:BACKGROUND:Intra-abdominal fibromatosis often involves the mesentery root which is non-resectable by conventional surgery. Multivisceral transplant (MVT), as a potential cure to non-resectable fibromatosis, has rarely been reported and the prognosis is unknown. METHODS:Six patients who underwent MVT for intra-abdomina...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.13186
更新日期:2018-03-01 00:00:00
abstract::Tacrolimus (TAC) is a calcineurin inhibitor that is used for cardiac allograft rejection. Efficacy and safety data of a combined TAC/mycophenolate mofetil (MMF) therapy in comparison with a TAC/cortisone therapy in heart recipients are lacking. We analysed the clinical outcome of 41 patients who received TAC in combin...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2006.00504.x
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:The aim of this study was to evaluate the efficacy of lamivudine (LAM) monoprophylaxis for patients with non-replicating hepatitis B virus (HBV) infection at orthotopic liver transplantation (OLT). METHODS:Among 128 liver recipients with HBV infection between 1994 and 2004 transplanted at our institution, 6...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2006.00557.x
更新日期:2007-03-01 00:00:00
abstract::Research with human transplant recipients has shown that mycophenolate mofetil (MMF) is a powerful and selective immunosuppressant for maintenance therapy following renal transplantation. An additional body of work suggests that it might also be a valuable tool for arresting ongoing rejection episodes. One randomized,...
journal_title:Clinical transplantation
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:
更新日期:1996-02-01 00:00:00
abstract::The transplantation of vascularized organs between species stimulates an intense rejection reaction by the recipient of the graft. The classification of the xenograft rejection reaction on the basis of the degree of genetic disparity between donor and recipient species and the presence or absence of preformed antibody...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:
更新日期:1994-04-01 00:00:00
abstract::Hepatic allograft rejection still remains an important problem following liver transplantation. Early acute rejection, occurring within three months of transplant, is a common event and usually of lesser significance with respect to prognosis than other non-immune-related post-transplant morbidities. However, little i...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2007.00788.x
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:Invasive fungal infections (IFI) are associated with significant morbidity and mortality in lung transplant recipients (LTRs). However, data outlining use of echinocandins in prophylaxis and therapy of LTRs are limited. METHOD:A single-center retrospective cohort study on all LTRs from January-2010 to Decem...
journal_title:Clinical transplantation
pub_type: 临床试验,杂志文章
doi:10.1111/ctr.13437
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Numerous studies of steroid withdrawal have been carried out in kidney and liver transplant recipients, but only a few in pancreas transplant recipients. Yet, pancreas transplant recipients could have significant long-term benefits from steroid withdrawal. METHODS:We performed a retrospective analysis to de...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1034/j.1399-0012.2000.140114.x
更新日期:2000-02-01 00:00:00
abstract::Autoantibodies are frequently detected after liver transplantation (LT), but their role is unclear. This study was designed to address three points: autoantibody prevalence pre-LT and over time up to five yr after LT, identification of possible predictors of autoantibody formation, and correlation between autoantibodi...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12498
更新日期:2015-02-01 00:00:00
abstract::As many as 50% of liver transplant patients suffer gastrointestinal (GI) disturbances post-transplant. Conversion from mycophenolate mofetil (MMF) to mycophenolate sodium (EC-MPS) alleviates GI symptom burden in renal transplant recipients. We employed a validated patient and physician-reported assessment to evaluate ...
journal_title:Clinical transplantation
pub_type: 临床试验,杂志文章
doi:10.1111/j.1399-0012.2011.01444.x
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:The benefits of pancreas transplantation are often difficult to measure. Here, we sought to determine the difference in quality of life for diabetic patients with and without a functional pancreas transplant alone (PTA). METHODS:Pancreas transplant alone cases from 1993 to 2015 were considered. An IRB-appro...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.13177
更新日期:2018-02-01 00:00:00
abstract::Temporary portocaval shunt and total hepatectomy is a technique used in the presence of toxic liver syndrome because of fulminant hepatic failure, hepatic trauma, primary non-function (PNF), and eclampsia. We performed this technique on four patients. An indication for anhepatic state was severe hemodynamic instabilit...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2009.01118.x
更新日期:2010-01-01 00:00:00
abstract:UNLABELLED: BACKGROUND:Rabbit anti-thymocyte globulin (rATG) induction reduces reperfusion injury and improves renal function in kidney recipients by means of properties unrelated to T-cell lysis. Here, we analyze intensive rATG induction (single dose, rATG(S) , vs. divided dose, rATG(D) ) for improved renal function ...
journal_title:Clinical transplantation
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1399-0012.2011.01425.x
更新日期:2012-01-01 00:00:00
abstract::Xenotransplantation is a potential strategy to overcome the shortage of human donor organs. As this technique has a major medical and psychological impact on patients and their family and friends, the attitude of patients currently waiting for organ transplantation is important. Therefore, we conducted a survey on the...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2010.01296.x
更新日期:2011-05-01 00:00:00
abstract::The practice of uncontrolled donation after cardiac death (uDCD) has been met with tepid interest within the United States transplant community. Hesitancy stems largely from fears of eroding public trust due to complex ethical issues involving consent. Beyond ethical concerns, uDCD creates unique logistic challenges t...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:10.1111/ctr.13474
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Chronic allograft nephropathy (CAN), associated with late-allograft dysfunction is caused by alloantigen-dependent and -independent mechanisms, and eventually leads to interstitial fibrosis (ci). Activation of complement cascade is considered to be a poor prognostic marker of graft survival. This study was d...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2005.00426.x
更新日期:2005-12-01 00:00:00
abstract:INTRODUCTION:The average age of patients undergoing liver transplantation (LT) is consistently increasing. The aim of this case-control study is to evaluate survival and outcome of patients ≥65 yr compared to younger patients undergoing LT. MATERIALS AND METHODS:From 10/00 to 4/08 we performed 330 primary LT, 31 (9.4%...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2010.01230.x
更新日期:2010-09-01 00:00:00