Prednisone‐Free Maintenance Immunosuppression—A 5‐Year Experience

Matas, Arthur J.; Kandaswamy, Raja; Gillingham, Kristen J.; McHugh, Lois; Ibrahim, Hassan N.; Kasiske, Bertram L.; Humar, Abhinav

doi:10.1111/j.1600-6143.2005.01051.x

Cited by 156 publications

(110 citation statements)

References 30 publications

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“…21,24 This low incidence of adverse events, especially infection, may be related to the relatively low mean cumulative dose of anti-thymocyte globulin (2.2 mg/kg) used to delay the initiation of CNI in contrast to the conventional 1.5 mg/kg/day for 3 to 7 days used in kidney transplantation as induction therapy. [25][26][27][28] Additionally, the control patients required additional immunosuppression to treat acute rejection, which might lead to increased overall immunosuppression load and an increased incidence of infection.…”

Section: Discussionmentioning

confidence: 99%

Preserving renal function in liver transplant recipients with rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitors

et al. 2007

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Early renal dysfunction following liver transplantation is associated with increased morbidity and mortality. To evaluate the impact of delayed initiation of calcineurin inhibitor on renal function, we conducted a retrospective study comparing 118 liver transplant recipients who received rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitor with 80 liver transplant recipients who received no antibody and early initiation of calcineurin inhibitor (control group). All patients received mycophenolate mofetil and steroids. Delayed calcineurin inhibitor initiation with anti-thymocyte globulin was associated with significant improvement in renal function throughout the first year post-transplant. At 12 months post-transplant, patients treated with this regimen experienced lower serum creatinine (1.4 Ϯ 0.5 versus 1.7 Ϯ 0.5 mg/dL, P Ͻ 0.001), a higher estimated glomerular filtration rate (57.4 Ϯ 20.5 versus 43.7 Ϯ 14.4 mL/min/1.73 m 2 , P Ͻ 0.001), and less dependence on dialysis (0.8% versus 13%, P Ͻ 0.001) in comparison with no antibody and early calcineurin inhibitor initiation. Patient survival and graft survival were similar between groups; however, there was a trend of a lower incidence of early biopsy-proven acute rejection with anti-thymocyte globulin. Overall infection and cytomegalovirus infection were significantly lower in anti-thymocyte globulin-treated patients, and there was no increased incidence of hepatitis C recurrence in comparison with controls. In conclusion, delayed initiation of calcineurin inhibitor with anti-thymocyte globulin in liver transplant recipients is safe and is associated with improvements in renal function and a lower incidence of early acute rejection in comparison with no antibody and early initiation of calcineurin inhibitor. Liver Transpl 14: 66-72, 2008.

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Section: Discussionmentioning

confidence: 99%

Preserving renal function in liver transplant recipients with rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitors

et al. 2007

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“…Rapid steroid elimination or steroid avoidance protocols are associated with a lower incidence of obesity (45,46). The benefit of late steroid withdrawal (Ն3 mo after transplantation) on weight gain is less clear (47).…”

Section: Obesitymentioning

confidence: 99%

Cardiovascular Disease in Transplant Recipients

Gill¹

2008

Clinical Journal of the American Society of Nephrology

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A cardiovascular disease event in a transplant recipient may be the result of a pretransplantation disease process, a direct effect of immunosuppressant medications, or the result of exposure to a variety of traditional and nontraditional risk factors after transplantation. Although the understanding of posttransplantation cardiovascular disease remains incomplete, there is evidence that the impact of posttransplantation cardiovascular disease has been decreased, through increased attention to this problem. In the absence of controlled studies to guide therapy, this review summarizes treatment of cardiovascular disease risk factors for which there is strong evidence of benefit in the nontransplantation setting, observational evidence of a similar risk in transplant recipients, and evidence that treatment can be safely administered to transplant recipients. Putative risk factors for posttransplantation cardiovascular disease for which the current level of evidence is insufficient to support specific treatment recommendations are also discussed. Potential new strategies to decrease the risk for cardiovascular disease events after transplantation in the future, including aggressive pretransplantation risk reduction, individualized treatments to prevent different types of cardiovascular disease, dedicated efforts to reduce cardiovascular disease events during transitions between dialysis and transplantation, and manipulation of immunosuppressant protocols, are also introduced.Clin J Am Soc Nephrol 3: S29 -S37, 2008. doi: 10.2215/CJN.02690707A lthough increased awareness of cardiovascular disease (CVD) has resulted in a reduction in CVD-related deaths over time (1,2), CVD remains the major known cause of death in transplant recipients (3) and is a significant barrier to improving long-term outcomes in kidney transplantation. The high risk for CVD in transplant recipients is in part explained by the high prevalence of conventional CVD risk factors (e.g., diabetes, hypertension, dyslipidemia) in this patient population; however, a significant portion of CVD risk in transplant recipients is unexplained by these factors (4) and may be related to pretransplantation exposure to chronic kidney disease (CKD)-related risk factors, ongoing exposure to CKD-related risk factors as a result of impaired allograft function, or to transplant-specific risk factors including those related to the use of immunosuppressant medications or infection. Given the relative absence of randomized, controlled trials in transplant recipients, this review summarizes treatments for which there is strong evidence of benefit in the nontransplantation setting, observational evidence of a similar risk in transplant recipients, and evidence that treatment can be safely administered to transplant recipients. The review also summarizes putative risk factors for posttransplantation CVD, for which the current level of evidence is insufficient to support specific treatment recommendations. Finally, the review introduces new strategies to decrease the risk for...

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“…The feasibility of complete avoidance of steroids in adults after renal transplantation was first suggested by an open label Canadian multicenter trial [5]. Since then, reports from other centers have also confirmed the efficacy and safety of various steroid minimization or avoidance regimens in adults [6][7][8][9]. These studies have also provided evidence that renal allograft recipients managed with less steroid exposure experience benefits such as a lower incidence of hypertension, diabetes, weight gain and hyperlipidemia.…”

Section: Introductionmentioning

confidence: 69%