Randomized, Prospective Trial of Cyclosporine Monotherapy Versus Azathioprine-Prednisone From Three Months After Renal Transplantation1

Hilbrands, L.B.; Hoitsma, Andries J.; Koene, R. A. P.

doi:10.1097/00007890-199604150-00009

Cited by 47 publications

(16 citation statements)

References 31 publications

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“…In the Pred withdrawal group, there was a significant decrease in mean arterial pressure without the need for more medication; patients continuing triple therapy required more antihypertensive medication to prevent a rise in mean arterial pressure. This positive effect of Pred withdrawal on BP has previously been reported for patients withdrawing prednisone at 3 mo or 1 yr after kidney transplantation (26,27). Long-term follow-up data (Ͼ5 yr) of patients withdrawing CsA from 3 mo after transplantation showed less cardiovascular deaths, less hypertension, and better renal function compared with patients continuing CsA (28).…”

Section: Discussionsupporting

confidence: 78%

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Withdrawal of Cyclosporine or Prednisone Six Months after Kidney Transplantation in Patients on Triple Drug Therapy

Gregoor¹,

Sévaux

Ligtenberg

et al. 2002

Journal of the American Society of Nephrology

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141

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ABSTRACT. Uncertainty exists regarding the necessity of continuing triple therapy consisting of mycophenolate mofetil (MMF), cyclosporine (CsA), and prednisone (Pred) after kidney transplantation (RTx). At 6 mo after RTx, 212 patients were randomized to stop CsA (n = 63), stop Pred (n = 76), or continue triple drug therapy (n = 73). The MMF dose was 1000 mg twice daily, target CsA trough levels were 150 ng/ml, and Pred dose was 0.10 mg/kg per d. Follow-up was until 24 mo after RTx. Biopsy-proven acute rejection occurred in 14 (22%) of 63 patients after CsA withdrawal compared with 3 (4%) of 76 in the Pred withdrawal group (P = 0.001) and 1 (1.4%) of 73 in the control group (P = 0.0001). Biopsy-proven chronic rejection was present in one patient in the control group, in nine patients after CsA withdrawal (P = 0.006 versus control group); and in four patients after discontinuation of Pred (NS). Graft loss occurred in two versus one patient after CsA or Pred withdrawal, respectively, and in two patients in the control group (NS). Patients who successfully withdrew CsA had a significantly lower serum creatinine during follow-up. Pred withdrawal resulted in a reduction in mean arterial pressure, and the total cholesterol/HDL ratio increased. In conclusion, rapid CsA withdrawal at 6 mo after RTx results in a significantly increased incidence of biopsy-proven acute and chronic rejection. Pred withdrawal was safe and resulted in a reduction in mean arterial pressure. However, patient and graft survival and renal function 2 yr after RTx were not different among groups.

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Section: Discussionsupporting

confidence: 78%

“…As a consequence of the intention-to-treat analysis, the effects of discontinuation of CsA are obscured by the proportion of patients in whom this drug was reintroduced (29%). In conversion studies with patients switching from CsA to azathioprine or MMF, beneficial effects on BP and lipid profile were also noted (18,26,29).…”

Section: Discussionmentioning

confidence: 99%

Withdrawal of Cyclosporine or Prednisone Six Months after Kidney Transplantation in Patients on Triple Drug Therapy

Gregoor¹,

Sévaux

Ligtenberg

et al. 2002

Journal of the American Society of Nephrology

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141

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“…From 1985 to 1989 all patients received CyA and prednisone during the first 3 months and azathioprine and prednisone thereafter. In the period from 1989 to 1992, patients were treated with CyA (starting with 12 mg/kg per day and tapering to 4 mg/kg per day at 3 months) and prednisone for the first 3 months and thereafter randomized for continued treatment with either azathioprine and prednisone or CyA monotherapy [9]. From 1992 to 1997 patients were treated with a combination of CyA and prednisone, and from 1997 patients have been treated in a randomized study with mycophenolate mofetil (MMF; 1 g b.i.d.…”

Section: Methodsmentioning

confidence: 99%

Outcome of renal transplantation in patients with systemic lupus erythematosus

Deegens¹,

Artz²,

Hoitsma³

et al. 2003

Transplant International

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Renal transplantation is considered to be a good treatment option for patients with systemic lupus erythematosus (SLE) and end-stage renal disease. However, in patients with glomerular diseases, the outcome of renal transplantation can be adversely affected by recurrence of the original disease. Furthermore, the post-transplant course might be complicated by pretransplant morbidity and treatment history. We studied the outcome of renal transplantation in patients with SLE who underwent transplantations in our center between 1968 and 2001. Patient and graft survival were compared with a matched control group. We specifically looked for any evidence of recurrent disease. There were 23 patients (two male, 21 female) with a mean + SD age of 34 f 12 years at transplantation. One patient developed renal failure with serological evidence of SLE activity at 61 months after transplantation. In the absence of urine abnormalities we favored the diagnosis of rejection, although recurrence of lupus nephritis could not formally be excluded. This was the only case of a possible recurrence of lupus nephritis. Two other patients developed extra-renal manifestations of SLE at 6 and 17 months after transplantation. Patient and graft survival rates at 5 years after transplantation were 86% and 68%, respectively. Survival rates were not significantly different from those of a matched control group, 95% and 78%, respectively. Recurrence of SLE after transplantation is rare. The results of renal transplantation in patients with SLE do not differ significantly from a matched control group. Renal transplantation is a good alternative for renal replacement therapy in patients with lupus nephritis.

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“…From 1985 to 1989 all patients received CsA and prednisone during the first 3 months and azathio prine and prednisone thereafter. In the period from 1989 to 1992, patients were treated with CsA (starting with 12 mg/kg/day and tapering to 4 mg/kg/day at 3 months) and prednisone for the first 3 months and thereafter randomized for continued treatment with either azathioprine and prednisone or CsA monotherapy (5). Since 1992, the combination of CsA and prednisone has been the corner stone of the immunosuppressive therapy.…”

Section: Methodsmentioning

confidence: 99%

Recurrence of Type I Membranoproliferative Glomerulonephritis After Renal Transplantation

Andrésdóttir

Assmann²,

Hoitsma³

et al. 1997

Transplantation

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Randomized, Prospective Trial of Cyclosporine Monotherapy Versus Azathioprine-Prednisone From Three Months After Renal Transplantation1

Cited by 47 publications

References 31 publications

Withdrawal of Cyclosporine or Prednisone Six Months after Kidney Transplantation in Patients on Triple Drug Therapy

Withdrawal of Cyclosporine or Prednisone Six Months after Kidney Transplantation in Patients on Triple Drug Therapy

Outcome of renal transplantation in patients with systemic lupus erythematosus

Recurrence of Type I Membranoproliferative Glomerulonephritis After Renal Transplantation

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