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- Ekberg, Henrik, et al.
(författare)
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Calcineurin Inhibitor Minimization in the Symphony Study: Observational Results 3 Years after Transplantation.
- 2009
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Ingår i: American Journal of Transplantation. - : Elsevier BV. - 1600-6135. ; 9, s. 1876-1885
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Tidskriftsartikel (refereegranskat)abstract
- The Symphony study showed that at 1 year posttransplant, a regimen based on daclizumab induction, 2 g mycophenolate mofetil (MMF), low-dose tacrolimus and steroids resulted in better renal function and lower acute rejection and graft loss rates compared with three other regimens: two with low-doses of cyclosporine or sirolimus instead of tacrolimus and one with no induction and standard cyclosporine dosage. This is an observational follow-up for 2 additional years with the same endpoints as the core study. Overall, 958 patients participated in the follow-up. During the study, many patients changed their immunosuppressive regimen (e.g. switched from sirolimus to tacrolimus), but the vast majority (95%) remained on MMF. During the follow-up, renal function remained stable (mean change: -0.6 ml/min), and rates of death, graft loss and acute rejection were low (all about 1% per year). The MMF and low-dose tacrolimus arm continued to have the highest GFR (68.6 +/- 23.8 ml/min vs. 65.9 +/- 26.2 ml/min in the standard-dose cyclosporine, 64.0 +/- 23.1 ml/min in the low-dose cyclosporine and 65.3 +/- 26.2 ml/min in the low-dose sirolimus arm), but the difference with the other arms was not significant (p = 0.17 in an overall test and 0.077, 0.039 and 0.11, respectively, in pair-wise tests). The MMF and low-dose tacrolimus arm also had the highest graft survival rate, but with reduced differences between groups over time, and the least acute rejection rate. In the Symphony study, the largest ever prospective study in de novo kidney transplantation, over 3 years, daclizumab induction, MMF, steroids and low-dose tacrolimus proved highly efficacious, without the negative effects on renal function commonly reported for standard CNI regimens.
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| 5. |
- Pokorna, E, et al.
(författare)
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Estimated and measured donor creatinine clearance are poor predictors of long-term renal graft function and survival
- 2002
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Ingår i: American Journal of Transplantation. - : Elsevier BV. - 1600-6135. ; 2:4, s. 373-380
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to evaluate estimated and measured donor renal function in predicting graft function long-term and to identify donor criteria associated with nonacceptable graft prognosis. In 200 consecutive cadaver donors creatinine clearance was measured at explantation and estimated using the Cockcroft formula on admission serum creatinine. Graft function was evaluated in recipients (n = 387) by 24-h creatinine clearance regularly during 3years after transplantation. Measured creatinine clearance correlated to some extent with long-term graft function, while Cockcroft estimation was slightly superior and similar to using donor age only. Kidneys from donors with intra-operative creatinine clearance less than or equal to555mL/min (median 50mL/min) produced acceptable recipient graft function of 48mL/min at 3years and 76% 3-year graft survival. Donor age greater than or equal to60years resulted in clearance at 3years of 29mL/min and 78% 3-year graft survival; adding the criteria of admission Cockcroft less than or equal to60mL/min, graft function at 3years (28mL/min) and 3-year graft survival (76%) were similar. In conclusion, creatinine-based estimates of the functional capacity of the donor kidney, calculated or intra-operatively measured, do little to improve the ability of donor age alone to predict long-term allograft function after renal transplantation, and nonacceptable donors are not discriminated.
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| 6. |
- Pokorna, E, et al.
(författare)
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Medical-record review of potential donor pool in the Czech Republic suggests a possible increase to more than double the number of donors
- 2003
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Ingår i: Transplant International. - : Frontiers Media SA. - 1432-2277 .- 0934-0874. ; 16:9, s. 633-638
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was the investigation of the maximal potential donor pool and causes of non-realized organ donation. On-site retrospective medical-record review was performed for all cases of patient death (n=1608) occurring in 1999 at 34 (83% of all) intensive care units (ICUs) in the region of the transplant center in Prague, Czech Republic. Two hundred and eighty-eight (18%) patients died with clinical signs of brain death. ICU physicians considered 111 of them as being potential donors at the time; 63 became donors and 48 did not. The remaining 177 patients with clinical signs of brain death were, in retrospect, assessed as being unsuitable (n=105) or suitable (n=72) for donation. The maximal potential donor rate was 55.7 per million population (pmp), with a more conservative estimate of 37.4 pmp. The actual donor rate was 18.1 pmp. For the maximal level to be approached, further educational efforts are warranted, targeting ICU physicians and concentrating on the identification of potential donors.
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