Switch from calcineurin inhibitors to sirolimus-induced renal recovery in heart transplant recipients in the midterm follow-up.

Abstract:

BACKGROUND:Calcineurin inhibitor (CI)-based immunosuppression has prolonged the survival of heart transplant recipients. However, CI-induced renal injury remains as a major problem in these patients. Sirolimus is an immunosuppressant with no significant impact on renal function. A limited number of recent papers have showed that the switch from CI to sirolimus improved renal function in late follow-up of heart transplant patients with CI-related nephrotoxicity. METHODS:Ten heart transplant recipients with CI-induced nephrotoxicity (creatinine 3.9+/-1.8 mg/dl) at a median of 701 (465 to 1325) days posttransplant had CI switched to sirolimus (target though levels 10 to 14 ng/ml) while mycophenolate mofetil (MMF, 3g/day) was maintained and adjusted according to white blood cell count. RESULTS:This maneuver caused a marked decrease in serum creatinine (P<0.00001) at 30 (1.2+/-0.4 mg/dl), 90 (1.3+/-0.4 mg/dl) and 180 (1.3+/-0.4 mg/dl) days post-conversion and a significant decrease in serum potassium levels (5.1+/-0.5 at baseline vs. 3.9+/-0.3 at 180 days, P<0.00005). After the drugs switch no changes in hemoglobin levels, white blood cell count, platelets count, blood glucose and glutamic oxaloacetic transaminase plasma levels were observed. Total cholesterol increased from 242+/-28 to 290+/-117 mg/dl (P>0.05) after 90 days and decreased to 216+/-58 mg/dl at day 180 (P>0.05) after statins dose adjustment. Rejection and infection rates were not modified by sirolimus. CONCLUSIONS:Conversion to a sirolimus-based immunosuppression regimen associated with MMF allowed striking renal function recovery in heart transplant recipients with calcineurin inhibitor-induced renal impairment at midterm follow-up.

journal_name

Transplantation

journal_title

Transplantation

authors

Bestetti R,Theodoropoulos TA,Burdmann EA,Filho MA,Cordeiro JA,Villafanha D

doi

10.1097/01.tp.0000177644.45192.a3

subject

Has Abstract

pub_date

2006-03-15 00:00:00

pages

692-6

issue

5

eissn

0041-1337

issn

1534-6080

pii

00007890-200603150-00008

journal_volume

81

pub_type

杂志文章
  • Dose study of thymoglobulin during conditioning for unrelated donor allogeneic stem-cell transplantation.

    abstract:BACKGROUND:Thymoglobulin given before allo-hematopoietic stem-cell transplantation (HSCT) from unrelated donors reduces acute graft-versus-host disease (GvHD), but the optimal dose is unknown. METHOD:Four different doses of Thymoglobulin were given to 162 patients with hematologic malignancies undergoing unrelated don...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:

    authors: Remberger M,Svahn BM,Mattsson J,Ringdén O

    更新日期:2004-07-15 00:00:00

  • A new T-cell receptor transgenic model of the CD4+ direct pathway: level of priming determines acute versus chronic rejection.

    abstract:BACKGROUND:T-cell receptor transgenic (TCR-tg) mouse models with direct CD4 alloreactivity will help elucidate mechanisms of transplant rejection and tolerance in vivo. Although such models exist, they are limited by unusual strain combinations or are based on model antigens. METHODS:A TCR-tg mouse with direct CD4 spe...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e31815e883e

    authors: Brennan TV,Hoang V,Garrod KR,Liu FC,Hayden T,Kim J,Kang SM

    更新日期:2008-01-27 00:00:00

  • Allograft rejection in athymic nude rats by transferred T cell subsets. II. The response of naive CD4+ and CD8+ thoracic duct lymphocytes to an isolated MHC class I disparity.

    abstract::Athymic PVG-rnu/rnu (RT1c) rats were grafted with skin bearing isolated MHC disparities 7-14 days in advance of cell transfer. The ability of naive CD4+ or CD8+ thoracic duct lymphocytes to induce rejection was assessed by adoptive transfer of one or both T cell subsets into nude recipients bearing congenic PVG.r1 (MH...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:

    authors: Bell EB,Rejali D,Whitby EH,Sparshott SM,Yang CP

    更新日期:1990-10-01 00:00:00

  • Comparison of sirolimus-based calcineurin inhibitor-sparing and calcineurin inhibitor-free regimens in cadaveric renal transplantation.

    abstract:INTRODUCTION:This study examines the efficacy and toxicity of sirolimus used as primary immunosuppression in combination with reduced dose tacrolimus (calcineurin inhibitor [CI]-sparing regimen) or mycophenolate mofetil (CI-free regimen) in high-risk cadaveric renal transplantation. METHODS:Seventy subjects were treat...

    journal_title:Transplantation

    pub_type: 临床试验,杂志文章

    doi:10.1097/01.tp.0000121504.69676.5e

    authors: Lo A,Egidi MF,Gaber LW,Amiri HS,Vera S,Nezakatgoo N,Gaber AO

    更新日期:2004-04-27 00:00:00

  • Comparison of human islet isolation outcomes using a new mammalian tissue-free enzyme versus collagenase NB-1.

    abstract:BACKGROUND:After the discontinuation of the manufacturing Liberase HI because of a small potential for prion disease transmission, Roche Diagnostics (Indianapolis, IN) developed a new enzyme product (Liberase MTF [mammalian tissue free]), which is similar to Liberase HI with the exception that no mammalian tissue is us...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e3181e117ce

    authors: O'Gorman D,Kin T,Imes S,Pawlick R,Senior P,Shapiro AM

    更新日期:2010-08-15 00:00:00

  • Amplification of immunological functions by subcutaneous injection of intermediate-high dose interleukin-2 for 2 years after autologous stem cell transplantation in children with stage IV neuroblastoma.

    abstract:BACKGROUND:Immunotherapy given post-autologous stem cell transplantation may eliminate residual tumor cells escaping the conditioning protocol. METHODS:Five children suffering from stage IV neuroblastoma were treated by recombinant interleukin-2 (IL-2) post-autologous peripheral blood stem cell transplantation. The pa...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-200010150-00019

    authors: Toren A,Nagler A,Rozenfeld-Granot G,Levanon M,Davidson J,Bielorai B,Kaplinsky C,Meitar D,Mandel M,Ackerstein A,Ballin A,Attias D,Biniaminov M,Rosenthal E,Brok-Simoni F,Rechavi G,Kaufmann Y

    更新日期:2000-10-15 00:00:00

  • B cells in cluster or in a scattered pattern do not correlate with clinical outcome of renal allograft rejection.

    abstract:BACKGROUND:The role of CD20+ B cells in renal allograft rejection has been reappreciated. Importantly, recent studies suggest a relation between CD20+ B cell aggregates and poorer clinical outcome. In the present study, we attempted to confirm these early reports in a tightly controlled patient population and to differ...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e3181860a74

    authors: Scheepstra C,Bemelman FJ,van der Loos C,Rowshani AT,van Donselaar-Van der Pant KA,Idu MM,ten Berge IJ,Florquin S

    更新日期:2008-09-27 00:00:00

  • Detection of Complement-binding Donor-specific Antibodies, Not IgG-antibody Strength Nor C4d Status, at Antibody-mediated Rejection Diagnosis Is an Independent Predictor of Kidney Graft Failure.

    abstract:BACKGROUND:Antibody-mediated rejection (AMR) remains associated with reduced kidney graft survival and no clear prognostic marker is available. METHODS:We investigated whether donor-specific antibodies (DSA) ability to bind C1q in comparison with AMR C4d status, both indirect signs of complement activation, improve ri...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0000000000002265

    authors: Malheiro J,Santos S,Tafulo S,Dias L,Martins S,Fonseca I,Almeida M,Pedroso S,Beirão I,Castro-Henriques A,Cabrita A

    更新日期:2018-11-01 00:00:00

  • Factors affecting graft survival after liver transplantation from donation after cardiac death donors.

    abstract:BACKGROUND:Liver transplantation from donation after cardiac death (DCD) donors is an increasingly common approach for expansion of the donor organ supply. However, transplantation with DCD livers results in inferior graft survival. In this study, we examined donor and recipient characteristics that are associated with...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000250936.73034.98

    authors: Lee KW,Simpkins CE,Montgomery RA,Locke JE,Segev DL,Maley WR

    更新日期:2006-12-27 00:00:00

  • Progression of renal dysfunction in cardiac transplantation after the introduction of everolimus in the immunosuppressive regime.

    abstract::The aim of this study was to analyze, in heart transplant patients, if renal function improvement after cyclosporine replacement by everolimus persists at the middle term and its predictors. We studied prospectively 56 patients in whom conversion was consecutively made. Forty-five patients completed the follow-up peri...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e31819452ce

    authors: Moro López JA,Almenar L,Martínez-Dolz L,Sánchez-Lázaro I,Agüero J,Buendía F,Ortiz V,Salvador A

    更新日期:2009-02-27 00:00:00

  • Increasing hematocrit reduces early posttransplant cardiovascular risk in diabetic transplant recipients.

    abstract:BACKGROUND:Cardiovascular disease remains epidemic in transplant recipients, despite aggressive treatment of cardiovascular risk factors. Thus, novel risk factors could play a role in the genesis of cardiovascular events in this population. METHODS:We evaluated the impact of early posttransplant anemia on cardiovascul...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.TP.0000084872.26360.C5

    authors: Djamali A,Becker YT,Simmons WD,Johnson CA,Premasathian N,Becker BN

    更新日期:2003-09-15 00:00:00

  • A novel risk score for mortality in renal transplant recipients beyond the first posttransplant year.

    abstract:BACKGROUND:All-cause mortality is high after kidney transplantation (KT), but no prognostic index has focused on predicting mortality in KT using baseline and emergent comorbidity after KT. METHODS:A total of 4928 KT recipients were used to derive a risk score predicting mortality. Patients were randomly assigned to t...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e3181b4ac2f

    authors: Hernández D,Sánchez-Fructuoso A,González-Posada JM,Arias M,Campistol JM,Rufino M,Morales JM,Moreso F,Pérez G,Torres A,Serón D,Spanish Late Allograft Dysfunction Study Group.

    更新日期:2009-09-27 00:00:00

  • Incidence, predictors, costs, and outcome of renal cell carcinoma after kidney transplantation: USRDS experience.

    abstract:INTRODUCTION:We carried out an analysis of the United States Renal Data System to determine the incidence, risk factors, prognosis, and costs associated with the diagnosis of renal cell carcinoma (RCC) after kidney transplantation. METHODS:This is a retrospective cohort of 40,821 Medicare primary renal transplant reci...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e3181f30479

    authors: Hurst FP,Jindal RM,Graham LJ,Falta EM,Elster EA,Stackhouse GB,Agodoa LY,Lentine KL,Salifu MO,Abbott KC

    更新日期:2010-10-27 00:00:00

  • Role of the thymus in transplantation tolerance in miniature swine: V. Deficiency of the graft-to-thymus pathway of tolerance induction in recipients of cardiac transplants.

    abstract:BACKGROUND:We have previously shown that both thymic immigrants (graft to thymus pathway) and thymic emigrants (thymus to graft pathway) are involved in tolerance to renal allografts in miniature swine treated with a short course of calcineurin inhibitors. This study investigates the role of these pathways in cardiac t...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000198735.17555.f1

    authors: Yamamoto S,Teranishi K,Kamano C,Samelson-Jones E,Arakawa H,Nobori S,Okumi M,Houser S,Shimizu A,Sachs DH,Yamada K

    更新日期:2006-02-27 00:00:00

  • Renal ischemia-reperfusion induces release of angiopoietin-2 from human grafts of living and deceased donors.

    abstract:BACKGROUND:Recent insights suggest that endothelial cell (EC) activation plays a major role in renal ischemia-reperfusion (I/R) injury. Interactions between ECs and pericytes via signaling molecules, including angiopoietins, are involved in maintenance of the vascular integrity. Experimental data have shown that enhanc...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e31829854d5

    authors: de Vries DK,Khairoun M,Lindeman JH,Bajema IM,de Heer E,Roest M,van Zonneveld AJ,van Kooten C,Rabelink TJ,Schaapherder AF,Reinders ME

    更新日期:2013-08-15 00:00:00

  • The nonessential role of a humoral antibody response in acute rat cardiac allograft rejection. An ultrastructural tracer study in an adoptive transfer model.

    abstract::Progressive microvascular endothelial damage is a characteristic feature of fulminant acute cardiac allograft rejection in the rat. Serial ultrastructural tracer studies using i.v. administered colloidal carbon and horseradish peroxidase have been performed in an adoptive transfer model to determine the role of cellul...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-198402000-00013

    authors: Lowry RP,Forbes RD

    更新日期:1984-02-01 00:00:00

  • FK506 treatment in combination with leflunomide in hamster-to-rat heart and liver xenograft transplantation.

    abstract:BACKGROUND:In the experiment described here, we investigated the effects of the immunosuppressants FK506 and leflunomide (Lef) on the survival of hamster hearts and liver xenografts in Lewis rats. METHODS:Lewis rats were used as recipients of hamster heart or liver grafts using different regimens of FK506 and Lef. Don...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-199810150-00004

    authors: Sankary HN,Yin DP,Chong AS,Ma LL,Blinder L,Shen JK,Foster P,Williams JW

    更新日期:1998-10-15 00:00:00

  • Evidence of intragraft interleukin-2-activated killer cells and allospecific cytolytic T lymphocytes in rejecting lung allografts.

    abstract::In vivo cell-mediated effector mechanisms of allograft destruction were investigated in a canine single-lung transplantation model. This large animal model permits direct longitudinal studies of immune effector cells from the grafts of individual recipients by bronchoalveolar lavage (BAL). Evidence was obtained that t...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-198911000-00026

    authors: Norin AJ,Kamholz SL

    更新日期:1989-11-01 00:00:00

  • Spleen plays an important role in maintaining tolerance after removal of the vascularized heart graft.

    abstract:BACKGROUND:This study addresses the question of the mechanism for maintaining tolerance to donor alloantigen in the absence of antigen and the role of secondary lymphoid tissues. METHODS:Depleting anti-CD4 antibody administration in conjunction with allogeneic heart transplantation generates donor-specific operational...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000259928.16003.aa

    authors: Chosa E,Hara M,Watanabe A,Matsuzaki Y,Nakamura K,Hamano K,Wood KJ,Onitsuka T

    更新日期:2007-05-15 00:00:00

  • Blood citrulline level is an exclusionary marker for significant acute rejection after intestinal transplantation.

    abstract:BACKGROUND:Serum citrulline is a marker for acute cellular rejection (ACR) after intestinal transplantation; however, its clinical utility has not yet been established. The goal of this study was to determine clearcut serum levels beyond which the diagnosis of acute rejection could be supported or refuted, and predicto...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000287186.04342.82

    authors: David AI,Selvaggi G,Ruiz P,Gaynor JJ,Tryphonopoulos P,Kleiner GI,Moon JI,Nishida S,Pappas PA,Conanan L,Weppler D,Esquenazi V,Levi DM,Kato T,Tzakis AG

    更新日期:2007-11-15 00:00:00

  • Blocking the CD28-B7 T-cell costimulatory pathway abrogates the development of obliterative bronchiolitis in a murine heterotopic airway model.

    abstract:BACKGROUND:CTLA4IgG that binds to B7 effectively inhibits the signaling of CD28/B7 pathway and induces antigen-specific T-cell unresponsiveness in vitro and in vivo. We examined whether the development of obliterative bronchiolitis in a murine heterotopic airway transplantation model is T cell dependent and whether CTL...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-200003150-00012

    authors: Yamada A,Konishi K,Cruz GL,Takehara M,Morikawa M,Nakagawa I,Murakami M,Abe T,Todo S,Uede T

    更新日期:2000-03-15 00:00:00

  • Thromboembolism in heart transplantation: role of prothrombin G20210A and factor V Leiden.

    abstract:BACKGROUND:Thromboembolism has been reported as a frequent complication after cardiac transplantation. Many risk factors for thrombosis may explain this, such as metabolic alterations and the use of cyclosporine. In the general population, two single nucleotide polymorphisms (SNPs), factor V Leiden and prothrombin G202...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000170545.42790.6f

    authors: Miriuka SG,Langman LJ,Evrovski J,Miner SE,Kozuszko S,D'Mello N,Delgado DH,Wong BY,Ross HJ,Cole DE

    更新日期:2005-09-15 00:00:00

  • Effect of antithymocyte globulin on histocompatibility antigen recognition in man.

    abstract::Nonmajor histocompatibility complex (non-MHC) antigens are important targets of graft rejection and graft-versus-host disease in clinical transplantation. Little is known regarding immunity to non-MHC antigens. To study this problem we evaluated the effect of antihuman thymocyte globulin (ATG) on reactivity in autolog...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-198102000-00001

    authors: Harada M,Gale RP

    更新日期:1981-02-01 00:00:00

  • Correction of decreased guanylate cyclase activity in diabetic rats by pancreatic islet transplantation.

    abstract::We have previously demonstrated that streptozotocin-induced diabetic rats have decreased guanylate cyclase (EC 4.6.1.2) activity in liver and other tissues which was returned to normal by the administration of exogenous insulin. Since successful pancreatic islet transplants have been shown to lower basal hepatic gluco...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:

    authors: Vesely DL,Selawry H,Levey GS

    更新日期:1979-06-01 00:00:00

  • Rejection responses to allogeneic hepatocytes by reconstituted SCID mice, CD4, KO, and CD8 KO mice.

    abstract:INTRODUCTION:The purpose of the current study was to investigate the capacity of CD4+, CD8+, or non-T cells to independently initiate acute rejection of allogeneic hepatocytes using reconstituted SCID, CD4 or CD8 knockout (KO) recipient mice. METHODS:Allogeneic hepatocytes (FVB/N, H-2q) were transplanted into C57BL/6....

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-200012270-00017

    authors: Bumgardner GL,Gao D,Li J,Baskin JH,Heininger M,Orosz CG

    更新日期:2000-12-27 00:00:00

  • Successful tapering of immunosuppression to low-dose monotherapy steroids after living-related human leukocyte antigen-identical renal transplantation.

    abstract:BACKGROUND:Living-related (LR) human leukocyte antigen (HLA)-identical renal transplant (RTx) recipients often receive standard immunosuppression, despite the absence of mismatched major HLA-antigens and the known complications of long-term use of immunosuppression. No data are available on the need for immunosuppressi...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e31819634eb

    authors: van de Wetering J,Gerrits JH,van Besouw NM,Ijzermans JN,Weimar W

    更新日期:2009-03-15 00:00:00

  • Prophylaxis with caspofungin for invasive fungal infections in high-risk liver transplant recipients.

    abstract:OBJECTIVE:The aim of this prospective, multicenter, noncomparative, open-label trial was to evaluate the prophylactic use of caspofungin in adult liver transplant recipients at high risk of developing invasive fungal infections (IFI). METHODS:Patients received caspofungin for at least 21 days. A successful treatment o...

    journal_title:Transplantation

    pub_type: 杂志文章,多中心研究

    doi:10.1097/TP.0b013e3181932e76

    authors: Fortún J,Martín-Dávila P,Montejo M,Muñoz P,Cisneros JM,Ramos A,Aragón C,Blanes M,San Juan R,Gavaldá J,Llinares P,GESITRA Study Group.

    更新日期:2009-02-15 00:00:00

  • Release of tumor necrosis factor, interleukin-2, and gamma-interferon in serum after injection of OKT3 monoclonal antibody in kidney transplant recipients.

    abstract::High levels of tumor necrosis factor-alpha, interleukin-2, and gamma-interferon appeared in the circulation of kidney transplant recipients after the first injection of the monoclonal antibody OKT3. This initial injection was systematically followed by fever. The three cytokines were released in all patients (n = 9), ...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-198904000-00008

    authors: Abramowicz D,Schandene L,Goldman M,Crusiaux A,Vereerstraeten P,De Pauw L,Wybran J,Kinnaert P,Dupont E,Toussaint C

    更新日期:1989-04-01 00:00:00

  • Selection of a suitable internal control gene for expression studies in pancreatic islet grafts.

    abstract::The use of real-time reverse transcription polymerase chain reaction to compare gene expression in different tissues and conditions requires normalization to an internal control that must be expressed at a constant level. Although a previous validation step is required to confirm that an internal control is appropriat...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000173790.12227.7b

    authors: Rodriguez-Mulero S,Montanya E

    更新日期:2005-09-15 00:00:00

  • Safety and efficacy of statin therapy in patients switched from cyclosporine a to sirolimus after cardiac transplantation.

    abstract:INTRODUCTION:Statins are an established therapy after cardiac transplantation. Sirolimus (Srl) has been used successfully in cardiac transplant patients. However, potential side effects are hyperlipidemia and interactions with statins. The aim of the study was to evaluate the safety and efficacy of statin therapy after...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e3181910eb2

    authors: Aliabadi AZ,Mahr S,Dunkler D,Grömmer M,Zimpfer D,Wolner E,Grimm M,Zuckermann AO

    更新日期:2008-12-27 00:00:00