A Controlled Trial of Cyclosporine in Renal Transplantation With Conversion to Azathioprine and Prednisolone After Three Months

Morris, Peter J.; French, Morris L. V.; Dunnill, M. S.; Hunnisett, Adrian; Ting, A.; Thompson, John F.; Wood, R. F.

doi:10.1097/00007890-198309000-00009

Cited by 97 publications

(19 citation statements)

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“…A total of 40 patients were recruited between May 2002 and January 2004, of whom 38 proceeded beyond randomization. Forty-one patients refused to participate, and 34 were excluded for reasons other than those specified in the inclusion criteria, including receipt of paired paediatric kidneys (3), relocating (2), undergoing investigation for co-morbidity (8), needle-phobia (2), delayed decision until after study closure (8).…”

Section: Resultsmentioning

confidence: 99%

“…These include complete withdrawal of CNIs at some point in the posttransplant period leaving recipients on steroids and azathioprine, substitution of CNI with mycophenolate mofetil (MMF), or simply minimizing the cyclosporin maintenance dose (7)(8)(9)(10)(11)(12)(13)(14). Although some success has been achieved with these strategies, withdrawal of CNIs, even as late as 1 year post-transplant, is often associated with acute rejection and the risk of late graft damage.…”

Section: Introductionmentioning

confidence: 99%

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A Randomized Controlled Trial of Late Conversion from CNI‐Based to Sirolimus‐Based Immunosuppression Following Renal Transplantation

Watson

Firth

Williams

et al. 2005

American Journal of Transplantation

123

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Maintenance immunosuppression with calcineurin inhibitors (CNIs) following renal transplantation is associated with nephrotoxicity and accelerated graft loss. We aimed to assess whether conversion to sirolimusbased immunosuppression would affect the progression of renal impairment.In this single center, randomized controlled trial, 40 renal transplant recipients between 6 months and 8 years post-transplant were randomly assigned to remain on their CNI (cyclosporin or tacrolimus) or to switch to sirolimus. The primary outcome measure was change in glomerular filtration rate (GFR) measurement at 12 months. Analysis was by intention-totreat.Of the 40 patients randomized, 2 patients never took the study drugs and were excluded, leaving 19 patients per group. There was a significant change in GFR at 12 months following conversion to sirolimus (12.9 mL/min, 95% CI 6.1-19.7; p < 0.001). Following conversion, the principal adverse events were the development of rashes (68%), particularly acne, and mouth ulcers (32%). No patient in either group experienced an acute rejection episode.In renal transplant recipients, a change in maintenance therapy from CNIs to sirolimus is associated with significant improvement in GFR at 12 months.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial of Late Conversion from CNI‐Based to Sirolimus‐Based Immunosuppression Following Renal Transplantation

Watson

Firth

Williams

et al. 2005

American Journal of Transplantation

123

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“…Particularly since the introduction of ciclosporin (CS) into clinical transplantation, early diag nosis of kidney transplant rejections has become more difficult [1,2], Clinical symptoms of rejection such as high fever, tenderness of the transplanted organ, elevated blood pressure and decrease of urine production are often masked because the more effective immunosup pression of this new drug mitigates the course of rejection [3,4]. Nephrotoxicity of CS is also a rather common finding and has further complicated the management of transplant recipitents because of the difficulty of distin guishing CS toxicity from allograft rejection [5,6].…”

Section: Introductionmentioning

confidence: 99%

Parameters of the Kallikrein-Kinin, Coagulation and Fibrinolytic Systems as Early Indicators of Kidney Transplant Rejection

Schrader¹,

Gallimore²,

Eisenhauer³

et al. 1988

Nephron

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In order to find early indicators of kidney transplant rejection before clinical symptoms were noticed, parameters of the coagulation, fibrinolytic and kallikrein-kinin systems were measured. Nineteen patients were followed before and daily after kidney transplantation during the first week and every second day in the following weeks. All patients received immunosuppressive therapy with ciclosporin and corticoids. Ten patients suffered from transplant rejection. The first rejection occurred on the 7th day after transplantation. Of all the parameters measured, kallikrein inhibition, β-FXIIa inhibition, plasminogen and antithrombin III were early indicators of kidney transplant rejections. A rise in these parameters could be demonstrated 2–3 days before clinical signs were noticed. In the other 9 patients no significant rises in antithrombin III, plasminogen, kallikrein inhibition and β-FXIIa inhibition could be found.

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“…Para evitar los problemas de nefrotoxicidad en el largo término de los CNI, una variedad de estrategias han sido exploradas; incluyendo el retiro del CNI en algún punto del tiempo durante el seguimiento postrasplante o simplemente minimizando la exposición. Sin embargo, la suspensión de los CNI, aún después de los 12 meses, está frecuentemente asociada con el rechazo agudo [7][8][9][10][11][12][13][14][15][16][17] .…”

Section: Introductionunclassified

24 month follow up to a late conversion from a calcineurin inhibitor regimen to everolimus in kidney transplant recipients

Montero¹,

Aldana²,

Torres³

2015

Rev. Colomb. Nefrol.

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Rev. Colomb. Nefrol. 2015; 2(2): 78 -95 Conversión tardía desde un régimen basado en inhibidores de calcineurina a everolimus en receptores de trasplante renal. Seguimiento a 24 meses 78Conversión tardía desde un régimen basado en inhibidores de calcineurina a everolimus en receptores de trasplante renal.Seguimiento a 24 meses.Camilo Montero 1 *, Guillermo Aldana 2 , Rodolfo Torres 3Resumen Introducción: La sobrevida del injerto renal a largo plazo ha permanecido estable, sin un aumento significativo en los últimos años. Dentro de las causas principales de pérdida de los injertos renales, en el largo plazo, se encuentran la muerte con injerto renal funcional por causas cardiovasculares, infecciosas y neoplásicas, y la lesión crónica del injerto por causas inmunológicas y no inmunológicas. Se ha atribuido al uso crónico de inhibidores de calcineurina (CNI, por su sigla en inglés), al aumento en el riesgo cardiovascular, a la incidencia de algunas infecciones y al aumento en la incidencia de neoplasias postrasplante. Igualmente, reportes en la literatura evidencian el aumento en la frecuencia de lesiones histológicas relacionadas con nefrotoxicidad por estos medicamentos, en la medida que el tiempo de exposición a los mismos aumenta. Se plantea que el cambio a esquemas basados en inhibidores mTOR puede disminuir alguno de estos efectos en el largo plazo. Por lo que se realizó un estudio de casos retrospectivo, de conversión tardía a inhibidores mTOR, en pacientes con esquema a base de CNI. Materiales y métodos:Se realizó un estudio de casos retrospectivo de centro único, incluyendo pacientes con más de 6 meses de trasplante renal, quienes fueron convertidos a everolimus despues de suspensión abrupta de CNI previa biopsia del injerto renal. Se excluyeron pacientes con evidencia en la biopsia de cambios de rechazo agudo, recaída de enfermedad glomerular o necrosis tubular aguda. Igualmente, se excluyeron pacientes con proteinuria >1 g en 24 horas y pacientes con rechazo agudo clínico en los 3 meses previos a la conversión. Se incluyeron un total de 40 pacientes, se realizó seguimiento posconversión de variables como tasa de filtración glomerular, proteinuria, lípidos, uso de hipotensores y efectos adversos, hasta el día 720 posconversión.

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A Controlled Trial of Cyclosporine in Renal Transplantation With Conversion to Azathioprine and Prednisolone After Three Months

Cited by 97 publications

References 0 publications

A Randomized Controlled Trial of Late Conversion from CNI‐Based to Sirolimus‐Based Immunosuppression Following Renal Transplantation

A Randomized Controlled Trial of Late Conversion from CNI‐Based to Sirolimus‐Based Immunosuppression Following Renal Transplantation

Parameters of the Kallikrein-Kinin, Coagulation and Fibrinolytic Systems as Early Indicators of Kidney Transplant Rejection

24 month follow up to a late conversion from a calcineurin inhibitor regimen to everolimus in kidney transplant recipients

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