Safety and Efficacy of Tacrolimus in Combination With Mycophenolate Mofetil (Mmf) in Cadaveric Renal Transplant Recipients1

Miller, John S.; Mendez, Robert; Pirsch, John D.; Jensik, Stephen C.

doi:10.1097/00007890-200003150-00035

Cited by 158 publications

(94 citation statements)

References 13 publications

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“…The addition of MMF to a tacrolimus-based immunosuppression with steroids and/or azathioprine seemed not to have been related to an improvement in lipid profile from available data, despite a reduction of acute rejection and therefore the need for bolus of corticosteroids (15,16). In fact, the reported incidences of hyperlipidemia and hypercholesterolemia were similar among patients who were receiving tacrolimus/azathioprine versus tacrolimus/MMF 1 g/d versus tacrolimus/ MMF 2 g/d (16).…”

Section: Hyperlipidemiamentioning

confidence: 93%

“…Tacrolimus/MMF association has not offered apparent advantages on BP control in comparison with dual therapy or triple therapy with steroids/tacrolimus/azathioprine or steroids/CsA/MMF, although detailed data are not available in several studies (15)(16)(17)(18)(19). However, tacrolimus/MMF combination has been tested as a steroid-sparing strategy after kidney transplantation in selected low-risk patients.…”

Section: Arterial Hypertensionmentioning

confidence: 99%

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Impact of Tacrolimus and Mycophenolate Mofetil Combination on Cardiovascular Risk Profile after Kidney Transplantation

Morales¹,

Domínguez‐Gil²

2006

Journal of the American Society of Nephrology

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Section: Hyperlipidemiamentioning

confidence: 93%

Section: Arterial Hypertensionmentioning

confidence: 99%

Impact of Tacrolimus and Mycophenolate Mofetil Combination on Cardiovascular Risk Profile after Kidney Transplantation

Morales¹,

Domínguez‐Gil²

2006

Journal of the American Society of Nephrology

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“…As far as minimization regimens are concerned, use of mycophenolate mofetil as an adjunctive agent spares tacrolimus exposure and may reduce the incidence of hyperglycemia (53)(54)(55). Efforts to spare CNI exposure with sirolimus, in contrast, have been associated with decreased insulin sensitivity and pancreatic ␤ cell function, resulting in exacerbated glucose intolerance (56).…”

Section: Long-term Posttransplantation Detection and Managementmentioning

confidence: 99%

New-Onset Diabetes Mellitus in the Kidney Recipient

Bloom¹,

Crutchlow²

2008

Clinical Journal of the American Society of Nephrology

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Advancing care has markedly improved survival after kidney transplantation, leaving patients susceptible to the effects of chronic transplant-associated morbidities. New-onset diabetes mellitus (NODM) is common in kidney recipients, threatening health and longevity by predisposing to microvascular and cardiovascular disease and by reducing graft survival. A strong rationale therefore exists for the aggressive treatment of NODM in kidney recipients to limit these complications. Screening for diabetes should be systematic and should span the pre-and posttransplantation periods. Once NODM is diagnosed in the kidney transplant patient, a comprehensive plan of therapy should be used to achieve treatment targets. As in the general population, treatment includes lifestyle modification and drug therapy as needed, but transplant-specific factors add complexity to the care of kidney recipients. Among these, minimizing immunosuppression-related toxicity without compromising graft outcomes is of paramount importance. Preexisting allograft functional impairment and the potential for significant interactions with immunosuppressive agents mandate that the expanding armamentarium of hypoglycemic agents be used with care. A team-oriented treatment approach that capitalizes on the collective expertise of transplant physicians, diabetologists, nurse-educators, and dieticians will optimize both glycemic control and the overall health of hyperglycemic kidney recipients.

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“…Initial efficacy studies that were designed to compare CsA and tacrolimus in kidney recipients demonstrated higher NODM risk with tacrolimus therapy (70,71,73). Subsequent studies of combination immunosuppression with tacrolimus and mycophenolate mofetil documented reduced rates of hyperglycemia when compared with the initial investigations, likely attributable to tacrolimus sparing with more potent adjunctive therapy (74,75). The relatively greater diabetogenicity of tacrolimus is also strongly supported by analysis of USRDS data, which indicated that tacrolimus was associated with a 48 to 66% increase in NODM risk by 2 to 3 yr after transplantation compared with CsA (10,11).…”

Section: Immunosuppression and Tahmentioning

confidence: 99%

Transplant-Associated Hyperglycemia

Crutchlow¹,

Bloom²

2007

Clinical Journal of the American Society of Nephrology

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New-onset diabetes has long been recognized as a common complication of kidney transplantation, promoting cardiovascular disease, death, and graft failure. Studies in recent years have begun to highlight the very high posttransplantation prevalence of the prediabetic states of impaired fasting glucose and impaired glucose tolerance and the significant repercussions of these states on cardiovascular health. Therefore, the overall burden of transplant-associated hyperglycemia (TAH), which encompasses new-onset diabetes and the prediabetic states, is far greater than previously appreciated. The kidney transplant population is predisposed to insulin resistance and to additional insults of hypertension and hyperlipidemia that, together with hyperglycemia, compose the metabolic syndrome and promote atherosclerosis. When recipients with an underlying, frequently nonmodifiable predisposition to glucose dysregulation encounter transplant-specific, often modifiable, diabetogenic exposures, TAH manifests. Aggressive screening will effectively detect TAH, whereas risk factor modification, lifestyle intervention, and, when appropriate, drug therapy may decrease its impact. Topics of future investigation should include the use of emerging diabetes therapies and avenues for the prevention and reversal of TAH.

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Safety and Efficacy of Tacrolimus in Combination With Mycophenolate Mofetil (Mmf) in Cadaveric Renal Transplant Recipients1

Abstract: Tacrolimus in combination with an initial dose of MMF 2 g/day is a very effective and safe regimen in cadaveric kidney transplant recipients.

Cited by 158 publications

References 13 publications

Impact of Tacrolimus and Mycophenolate Mofetil Combination on Cardiovascular Risk Profile after Kidney Transplantation

Impact of Tacrolimus and Mycophenolate Mofetil Combination on Cardiovascular Risk Profile after Kidney Transplantation

New-Onset Diabetes Mellitus in the Kidney Recipient

Transplant-Associated Hyperglycemia

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