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- Ekberg, Henrik, et al.
(author)
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Cyclosporine, tacrolimus and sirolimus retain their distinct toxicity profiles despite low doses in the Symphony study.
- 2010
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In: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. - : Oxford University Press (OUP). - 1460-2385. ; 25, s. 2004-2010
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Journal article (peer-reviewed)abstract
- BACKGROUND: Reducing side effects of immunosuppressive regimens has become a priority in transplantation medicine because of the large number of patients and grafts that succumb to infection in the short term and cardiovascular disease in the long term. The Symphony study was a 12-month prospective, randomized, open-label, multi-centre, four parallel arm study that aimed to evaluate the safety and efficacy of low-dose immunosuppressive regimens compared with a standard-dose regimen in renal transplant recipients. This sub-analysis focuses on specific toxicities observed with the low-dose regimens. METHODS: Adult patients (n = 1645) scheduled to undergo renal transplantation received low-dose cyclosporine (CsA), tacrolimus (Tac) or sirolimus (SRL) in addition to daclizumab induction or standard-dose cyclosporine without induction. All patients received mycophenolate mofetil and corticosteroids. We evaluated the incidence of adverse events (AEs), tested specific group differences and assessed the relationship of selected AEs with drug levels. RESULTS: The four arms had similar incidences of AEs, but serious AEs were more common with low-dose SRL and led to more discontinuations. Infections were the most common AEs, with the highest incidence in the standard-dose CsA group, in particular, cytomegalovirus (CMV) infections. Low-dose Tac had the most reports of new-onset diabetes, leucopenia and diarrhoea. Low-dose SRL negatively influenced triglycerides, wound healing, lymphocele and anaemia. We found only weak relationships between specific AEs and drug levels. CONCLUSIONS: Despite the low doses, CsA, Tac and SRL retained distinct and different toxicity profiles. These findings may be of relevance for tailoring specific immunosuppressive regimens to patients with particular needs.
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| 4. |
- Friman, Styrbjörn, 1948, et al.
(author)
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Kidney transplantation--a 46-year experience from the Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
- 2011
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In: Clinical transplants. - 0890-9016. ; , s. 119-25
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Journal article (peer-reviewed)abstract
- The limiting factor in organ transplantation is the availability of organs. Ongoing work to improve donation rates both at the public and the organizational level in donating hospitals is essential. We also think that encouragement of live donation is important, and the possibility of ABO incompatible transplantation has increased the number of LD transplantations. The one-year graft survival rate is excellent and focus has shifted towards achieving long-term results to reduce the attrition rate. There is also an increasing interest in studying and working to reduce comorbidities on a long-term basis and thus, improve survival rates and recipient quality of life.
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| 5. |
- Wolfbrandt, A, et al.
(author)
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What are we waiting for? Analyses of factors influencing cold ischemia time.
- 2010
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In: Transplantation proceedings. - : Elsevier BV. - 1873-2623 .- 0041-1345. ; 42:10, s. 4436-4437
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Journal article (peer-reviewed)abstract
- Introduction Cold ischemia time (CIT) influences long-term graft survival after deceased donor (DD) kidney transplantation. The aim of the present study was to identify factors that influenced CIT at our institution, seeking to lay ground for improvement. Patients and Methods Patients who underwent DD kidney transplantations from November 2008 to April 2009 were included in the study. In a prospective protocol the times for various events were registered. The 40 DD kidney transplantations included 26 “paired” kidneys from the same donor and 14 “single” kidneys. Results The mean CIT was 15.2 hours ± 4.2 hours (range, 7.0–23.9). “First kidney” was 13.3 hours ± 3.4 versus 19.2 ± 2.8 hours for the “second kidney” (P < .001). The waiting time for the operating room (OR) was 2.4 hours (range, 0–12 hours). Twenty-five percent of the patients waited more than 4 hours. Patients arriving at the hospital at the same time as or before the kidney retrieval showed a CIT of 13.4 ± 3.9 hours compared with 17.4 ± 3.4 hours for patients that arrived after the retrieved kidney (P < .01). Conclusion We identified factors influencing CIT that could lay the foundation for improvement. An extended cooperation and exchange with another transplantation unit for the “second kidney” could reduce the CIT. To reduce the waiting time for OR at the hospital to less than 2 hours and to get the recipient into the hospital before the kidney arrives are efforts that could reduce CIT.
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