Abstract:
:Mycophenolate mofetil (MMF) combined with conventional cyclosporine and steroids doses efficiently prevents acute rejection in kidney transplants. However, this regimen has been associated with an increased incidence of cytomegalovirus (CMV) disease and leukopenia, specially in patients receiving MMF at 3 g/d, suggesting that the combination of two powerful immunosuppressants carries the risk of overimmunosuppression. For this reason, we treated a group of patients with MMF 3 g/d combined with low cyclosporine and steroids doses. Eighty-two kidney transplants performed at two centers and enrolled in the European Mycophenolate Mofetil Cooperative Study were randomized to receive: A) placebo (n = 27); B) MMF 2 g/d (n = 27); and C) MMF 3 g/d (n = 28). In this double blind study all patients received cyclosporine and steroids at conventional doses. Fifteen kidney transplants enrolled in an MMF open pharmacokinetic study were treated with MMF 3 g/day combined with low cyclosporine and steroid doses (group D). Efficacy was evaluated as the incidence of biopsy proven acute rejection, and safety focused on CMV disease and leukopenia. Patients receiving MMF showed a low incidence of biopsy proven rejection (B) 18.5%; C) 10.7%; and D) 13.3%). Patients of group C had a high incidence of CMV disease (35.7%) when compared with the other groups (lower than 8%). Incidence of leukopenia was higher in patients treated with MMF (B) 25.9%; C) 39.3%; and D) 40%) than in placebo treated patients (7.4%). Patients in group (C) displayed leukopenia mainly in the context of CMV disease, while patients of group (D) had leukopenia not related to CMV infection. All patients of group (D) who presented leukopenia recovered after MMF reduction dose, while in group (C) there were 5 out of 28 patients who required MMF withdrawal. We propose that a reasonable approach to take advantage of a powerful non-nephrotoxic immunosuppressant such as MMF, could be the administration of this drug at 3 g/d from the time of transplantation combined with low CsA and steroid doses.
journal_name
Clin Transplantjournal_title
Clinical transplantationauthors
Moreso F,Serón D,Morales JM,Cruzado JM,Gil-Vernet S,Pérez JL,Fulladosa X,Andrés A,Grinyó JMsubject
Has Abstractpub_date
1998-06-01 00:00:00pages
198-205issue
3eissn
0902-0063issn
1399-0012journal_volume
12pub_type
临床试验,杂志文章,随机对照试验abstract::Kidney transplant wait-list management is becoming increasingly complex. We introduced a novel wait-list management strategy at our center, the Transplant Readiness Assessment Clinic (TRAC), whereby patients whose Kidney Allocation Scores surpass a threshold are actively managed. From January 1, 2016 through June 30, ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.13406
更新日期:2018-11-01 00:00:00
abstract::These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of tuberculosis in the pre- and post-transplant period. The challenges of screening for both latent and active TB in the setting of transplantation are...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.13513
更新日期:2019-09-01 00:00:00
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::Omega-3 fatty acids have been shown to play a role in preventing development of both acute and chronic rejection. New evidence also suggests that HMGCoA reductase inhibitors may have an immunomodulatory effect and may decrease the incidence of rejection in both animal and human transplant models. Omega-3 fatty acids a...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:
更新日期:1995-06-01 00:00:00
abstract::Chronic allograft nephropathy (CAN) leads to the majority of late graft loss following renal transplantation. Detection of CAN is often too late to permit early intervention and successful management. Most current strategies for managing CAN rely on minimizing or eliminating calcineurin inhibitors (CNIs) once CAN has ...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:10.1111/j.1399-0012.2009.01057.x
更新日期:2009-11-01 00:00:00
abstract::Differentiating acute pyelonephritis (APN) from acute rejection (AR) in renal allograft biopsies can sometimes be difficult because of overlapping clinical and histologic features, lack of positive urine cultures,and variable response to antibiotics. We wanted to study differential gene expression between AR and APN u...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12795
更新日期:2016-09-01 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::The majority of kidney transplant recipients die from cardiovascular events. Physical activity may be a modifiable risk factor for cardiovascular disease following transplant. The goal of our study was to examine adherence to a physical activity intervention following kidney transplant and its impact on metabolic para...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12553
更新日期:2015-06-01 00:00:00
abstract::Lymphocyte cultures grown from liver allograft biopsies were shown to exhibit alloreactivity towards donor cells as measured by primed lymphocyte testing (PLT). The PLT specificity was determined in assays using HLA typed panel cells and/or by inhibition testing with HLA specific monoclonal antibodies. Certain culture...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:
更新日期:1988-01-01 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::The shortage of kidney donors has led to broadening of the acceptance criteria for deceased donor organs beyond the traditional use of young donors. We determined long-term post-transplant outcomes in recipients of dual expanded criteria donor kidneys (dECD, n = 44) and compared them to recipients of standard criteria...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2009.00956.x
更新日期:2009-06-01 00:00:00
abstract::Simultaneous pancreas and kidney (SPK) and pancreas after kidney (PAK) transplant are both potential options for diabetic ESRD patients. Historically, PAK pancreas graft outcomes were felt to be inferior to SPK pancreas graft outcomes. Little is known about outcomes in the modern era of transplantation. We analyzed ou...
journal_title:Clinical transplantation
pub_type: 临床试验,杂志文章
doi:10.1111/ctr.13732
更新日期:2019-12-01 00:00:00
abstract:INTRODUCTION:Heart transplant (HTx) recipients need to follow a complex therapeutic regimen. We assessed the international prevalence and variability in nonadherence to six nonpharmacologic treatment components (physical activity, sun protection, diet, alcohol use, nonsmoking, and outpatient follow-up visits). METHODS...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.13280
更新日期:2018-07-01 00:00:00
abstract::A lack of research exploring post-transplant process optimization to reduce readmissions and increasing readmission rates at our center from 2009 to 2013 led to this study, aimed at assessing the effect of patient and process factors on 30-d readmission rates after kidney transplantation. This was a retrospective case...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12748
更新日期:2016-07-01 00:00:00
abstract::Subclinical acute rejection (SAR) occurs in about 30% of stable renal transplant patients and may be a risk factor for a poor allograft outcome. In the present study, the prevalence and clinical features of subclinical rejection, and the expression of immune activation markers in surveillance graft biopsies were asses...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2004.00170.x
更新日期:2004-08-01 00:00:00
abstract::Atherosclerosis is a chronic inflammatory process affecting mainly elastic and muscular arteries. Although small arteries and arterioles are usually spared, atherosclerosis can occur in these small vasculatures for a very short period. Here we report a case of atherosclerosis-like lesions that occurred in a transplant...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1034/j.1399-0012.16.s8.7.x
更新日期:2002-01-01 00:00:00
abstract::Survival despite prolonged non-adherence with immunosuppression is rare but has been reported in kidney, lung, and liver transplantation. Its occurrence in heart transplantation is quite rare. Our study was prompted by an index patient who survived despite prolonged medication non-adherence. Prospective consent and bl...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.13834
更新日期:2020-05-01 00:00:00
abstract::Post-transplant outcome of kidney allografts depends on various factors, one of which may be the compatibility in volume between graft and recipient. However, previous studies adjusted the graft volume only for recipient's size. As the adjusted graft volume for donor's size would be substituted of nephron number more ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2011.01426.x
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:This study aims to investigate the association between social behaviors of increased-risk donors (IRD) and recipient outcomes after heart transplantation. METHODS:The United Network for Organ Sharing (UNOS) database was queried to identify patients who received a heart transplant between 2004 and 2015. Pati...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.13787
更新日期:2020-03-01 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::We sought to determine the incidence, risk factors, and consequences of acute rejection (AR) after conversion from a calcineurin inhibitor (CNI) to a proliferation signal inhibitor (PSI) in maintenance heart transplantation. Relevant clinical data were retrospectively obtained for 284 long-term heart transplant recipi...
journal_title:Clinical transplantation
pub_type: 杂志文章,多中心研究
doi:10.1111/ctr.12241
更新日期:2013-11-01 00:00:00
abstract::The current pandemic SARS-CoV-2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high-complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID-19 o...
journal_title:Clinical transplantation
pub_type: 杂志文章,多中心研究
doi:10.1111/ctr.14063
更新日期:2020-10-01 00:00:00
abstract::Histoplasma capsulatum is a dimorphic fungus that most often causes asymptomatic infection in the immunocompetent population. In immunocompromised patients, including solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, however, it is likely to cause severe life-threatening infection. Post-...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:10.1111/ctr.13087
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Recent studies demonstrated safety and efficacy of heart transplantation (HT) from hepatitis C virus (HCV)-positive donors. We sought to evaluate the impact of HCV donor status on the outcomes of patients undergoing HT in the United States. METHODS:We analyzed a retrospective cohort of adult patients from t...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.14220
更新日期:2021-01-08 00:00:00
abstract:BACKGROUND:There have been no published data on use of the the newer immunosuppressants tacrolimus and mycophenolate mofetil (MMF) in high immunological risk renal transplantation. We therefore undertook a prospective study to systematically assess outcomes using these agents as part of an aggressive immunosuppressive ...
journal_title:Clinical transplantation
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1111/j.1399-0012.2005.00275.x
更新日期:2005-02-01 00:00:00
abstract::Cutaneous cryptococcosis is an uncommon manifestation of disseminated cryptococcal disease. We report a liver transplant recipient presenting with onset over 3 days of progressive pain and swelling of the lower extremity and foot with erythema and heat. Cryptococcal cellulitis was documented, but in retrospect the cli...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:
更新日期:1994-08-01 00:00:00
abstract::Calcineurin inhibitors (CNIs) have considerably improved renal allograft survival. However, their chronic use has various adverse effects, including hypertension, hyperlipidemia, and nephrotoxicity. We conducted a retrospective study of kidney transplant recipients using a CNI withdrawal protocol. Eleven of 13 patient...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12274
更新日期:2013-11-01 00:00:00
abstract::Considering the relevance of the migratory processes in Western societies, the attitudes toward organ donation after death are analyzed by means of a survey applied to a representative random sample of the resident immigrant population in Spain, comprising 1202 subjects (estimated margin of error of ± 2.88%, p = q, p ...
journal_title:Clinical transplantation
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1399-0012.2011.01586.x
更新日期:2012-05-01 00:00:00
abstract::Islet yield is an important predictor of acceptable glucose control after total pancreatectomy with islet autotransplantation (TP-IAT). We assessed if pancreas volume calculated with preoperative MRI could assess islet yield and postoperative outcomes. We reviewed dynamic MRI studies from 154 adult TP-IAT patients (20...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.14008
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Relationships between race/ethnicity, recipient medical insurance, and living donor kidney transplantation (LKT) are incompletely described. METHODS:Associations between medical insurance and LKT were assessed in 447 recipients at a southeastern US transplant center. Primary and secondary payers were includ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12168
更新日期:2013-07-01 00:00:00