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Renal Transplant Pa...
Renal Transplant Patients at High Risk of Acute Rejection Benefit From Adequate Exposure to Mycophenolic Acid.
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van Gelder, Teun (author)
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Tedesco Silva, Helio (author)
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de Fijter, Johan W (author)
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Budde, Klemens (author)
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Kuypers, Dirk (author)
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Arns, Wolfgang (author)
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Soulillou, Jean Paul (author)
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Kanellis, John (author)
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Zelvys, Arunas (author)
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- Ekberg, Henrik (author)
- Lund University,Lunds universitet,Enheten för forskning kring njurfunktion och njursjukdom,Kirurgi,Forskargrupper vid Lunds universitet,Renal Research Unit,Surgery,Lund University Research Groups
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Holzer, Herwig (author)
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Rostaing, Lionel (author)
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Mamelok, Richard D (author)
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(creator_code:org_t)
- 2010
- 2010
- English.
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In: Transplantation. - 1534-6080. ; 89, s. 595-599
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http://dx.doi.org/10...
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Abstract
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- BACKGROUND.: To better define subpopulations in which achieving adequate mycophenolic acid (MPA) concentrations quickly would be important, a post hoc exploratory analysis on the fixed-dose concentration-controlled database was performed, comparing high- versus low-risk renal transplant patients. METHODS.: Renal transplant patients were treated with mycophenolate mofetil, corticosteroids, and cyclosporine A or tacrolimus. Patients were defined as "high risk" if they had one or more of the following characteristics: delayed graft function, second or third transplantation, panel reactive antibodies >15%, four or more human leukocyte antigen mismatches, or were of black race. RESULTS.: A total of 549 patients (61%) were classified as high risk, of whom 284 were on cyclosporine A treatment and 265 on tacrolimus. In high-risk patients, the difference in rejection incidence was 14.3% in the MPA-area under the concentration (AUC) less than 30 mg hr/L vs. 7.8% in the MPA-AUC more than or equal to 30 mg hr/L groups (P=0.025) during the first month after transplantation; whereas, in low-risk patients, there were similar rejection rates (5.7% vs. 4.5%). In the subgroup of high-risk tacrolimus-treated patients, the difference in acute rejection incidence in the first month between patients with MPA-AUC0-12 less than or more than or equal to 30 mg hr/L was most pronounced: 16 of 67 patients (23.9%) vs. 18 of 173 patients (10.4%); P=0.012. CONCLUSIONS.: The incidence of acute rejection is higher in high-risk patients if MPA-AUC0-12 is below 30 mg hr/L. In contrast, a difference in acute rejection incidence in low-risk patients with MPA-AUC0-12 less than or more than or equal to 30 mg hr/L was not observed. This supports the use of a higher mycophenolate mofetil starting dose in selected patient populations early after transplantation.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
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- art (subject category)
- ref (subject category)
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- By the author/editor
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van Gelder, Teun
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Tedesco Silva, H ...
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de Fijter, Johan ...
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Budde, Klemens
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Kuypers, Dirk
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Arns, Wolfgang
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show more...
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Soulillou, Jean ...
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Kanellis, John
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Zelvys, Arunas
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Ekberg, Henrik
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Holzer, Herwig
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Rostaing, Lionel
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Mamelok, Richard ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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Transplantation
- By the university
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Lund University