Long-term impact of discontinued or reduced calcineurin inhibitor in patients with chronic allograft nephropathy

Weir, Matthew R.; Ward, Mary Traver; Blahut, Steven A.; Klassen, David K.; Cangro, Charles B.; Bartlett, Stephen T.; Fink, Jeffrey C.

doi:10.1046/j.1523-1755.2001.0590041567.x

Cited by 167 publications

(134 citation statements)

References 27 publications

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“…That these effects may translate into a clinically relevant benefit in humans, however, is unproved. Data in support of this possibility are generated by sequential studies showing improvements in graft structure and function after replacement of calcineurin inhibitors with MMF (29,30). These findings, however, may reflect a spontaneous recovery from the nephrotoxic effects of previous cyclosporine or tacrolimus treatment, rather than a specific protective effect of MMF against CAN.…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate Mofetil versus Azathioprine for Prevention of Chronic Allograft Dysfunction in Renal Transplantation

Remuzzi¹,

Cravedi²,

Costantini³

et al. 2007

Journal of the American Society of Nephrology

104

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The Mycophenolate Steroids Sparing (MYSS) study found that in renal transplant recipients who were on immunosuppressive therapy with the cyclosporine microemulsion Neoral, mycophenolate mofetil (MMF) was not better than azathioprine in preventing acute rejection at 21 mo after transplantation and was 15 times more expensive ; P ‫؍‬ 0.53), and adverse events were similar on azathioprine (n ‫؍‬ 124) and MMF (n ‫؍‬ 124), respectively. Outcomes in the two groups were comparable also among patients with or without steroid therapy, considered separately. In kidney transplantation, the long-term risk/benefit profile of MMF and azathioprine therapy in combination with cyclosporine Neoral is similar. In view of the cost, standard immunosuppression regimens for kidney transplantation should perhaps include azathioprine rather than MMF.

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Section: Discussionmentioning

confidence: 99%

Mycophenolate Mofetil versus Azathioprine for Prevention of Chronic Allograft Dysfunction in Renal Transplantation

Remuzzi¹,

Cravedi²,

Costantini³

et al. 2007

Journal of the American Society of Nephrology

104

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“…The predictable impact of maintaining such a low blood level of CsA in the long-term is a slower rate of renal function deterioration and eventual graft loss in respect to the standard CsA regimen (7,8,34,35). Chronic CsA nephropathy is indeed one of the most important recognized causes of chronic renal allograft dysfunction (34,36,37).…”

Section: Discussionmentioning

confidence: 99%

“…That, however, results in higher risk of acute rejection and graft failure, even after relatively long periods from withdrawal (6). Calcineurin inhibitors are important factors contributing to deterioration of the transplant kidney in the long term (7)(8)(9). This prompted some investigators to reduce or avoid cyclosporine in their antirejection protocols by a delay, however, of few years after transplantation to minimize insufficient immunosuppression and consequent immune-mediated events that may lead to chronic nephropathy (6).…”

mentioning

confidence: 99%

Renal Transplantation

Gotti¹,

Perico²,

Perna³

et al. 2003

Journal of the American Society of Nephrology

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“…CNI are causative agents of thrombotic microangiopathy and can result independently in progressive and irreversible arteriolar hyaline changes and tubulointerstitial fibrosis (38,41,44). A number of approaches have attempted to stave off nephrotoxicity through CNI avoidance (45)(46)(47), withdrawal (48 -54), or minimization (51,(55)(56)(57). The rejection risk with any of these strategies is relatively small (Ͻ10%), and kidney allograft function may improve by up to 7 ml/min (52)(53)(54).…”

Section: Chronic Allograft Dysfunctionmentioning

confidence: 99%

Medical Care of Kidney Transplant Recipients after the First Posttransplant Year

Djamali

Samaniego²,

Muth³

et al. 2006

Clinical Journal of the American Society of Nephrology

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Kidney transplantation is the treatment of choice for patients with ESRD. Despite improvements in short-term patient and graft outcomes, there has been no major improvement in long-term outcomes. The use of kidney allografts from expandedcriteria donors, polyoma virus nephropathy, underimmunosuppression, and incomplete functional recovery after rejection episodes may play a role in the lack of improvement in long-term outcomes. Other factors, including cardiovascular disease, infections, and malignancies, also shorten patient survival and therefore reduce the functional life of an allograft. There is a need for interventions that improve long-term outcomes in kidney transplant recipients. These patients are a unique subset of patients with chronic kidney disease. Therefore, interventions need to address disease progression, comorbid conditions, and patient mortality through a multifaceted approach. The Kidney Disease Outcomes Quality Initiative from the National Kidney Foundation, the European Best Practice Guidelines, and the forthcoming Kidney Disease: Improving Global Outcomes clinical practice guidelines can serve as a cornerstone of this approach. The unique aspects of chronic kidney disease in the transplant recipient require the integration of specific transplant-oriented problems into this care schema and a concrete partnership among transplant centers, community nephrologists, and primary care physicians. This article reviews the contemporary aspects of care for these patients.

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Long-term impact of discontinued or reduced calcineurin inhibitor in patients with chronic allograft nephropathy

Cited by 167 publications

References 27 publications

Mycophenolate Mofetil versus Azathioprine for Prevention of Chronic Allograft Dysfunction in Renal Transplantation

Mycophenolate Mofetil versus Azathioprine for Prevention of Chronic Allograft Dysfunction in Renal Transplantation

Renal Transplantation

Medical Care of Kidney Transplant Recipients after the First Posttransplant Year

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