Efficacy and safety of tacrolimus compared with ciclosporin a in renal transplantation: seven-year observational results

Transplant International Efficacy and safety of tacrolimus compared with ciclosporin a in renal transplantation: seven-year observational results

Abstract

Background

The European Tacrolimus vs. Ciclosporin-A Microemulsion (CsA-ME) Renal Transplantation Study demonstrated that tacrolimus decreased acute rejection rates at 6 months.

Methods

Primary endpoints of this investigator-initiated, observational 7-year follow-up study were acute rejection rates, patient and graft survival rates, and a composite endpoint (BPAR, graft loss, patient death). We analyzed data from the original ITT population (n=557; 286 tacrolimus, 271 CsA-ME).

Results

237 tacrolimus and 208 CsA-ME patients provided data. At 7 years, Kaplan-Meier estimated rates of patients free from BPAR were 77.1% in the tacrolimus arm and 59.9% in the CsA-ME arm, graft survival rates amounted to 82.6% and 80.6%, and patient survival rates to 89.9% and 88.1%. Estimated combined endpoint-free survival rates were 60.2% in the tacrolimus arm and 47.0% in the CsA-ME arm (p=<0.0001).

A higher number of patients from the CsA-ME arm crossed over to tacrolimus during 7 year follow-up: 19.7% vs. 7.9% (p=<0.002). More patients in the tacrolimus group stopped steroids and received immunosuppressive monotherapy. Significantly more CsA-ME patients received lipid-lowering medication, experienced cosmetic and cardiovascular adverse events.

Conclusions

Tacrolimus-treated renal transplant recipients had significantly higher combined endpoint-free survival rates mainly driven by lower acute rejection rates despite less immunosuppressive medication at 7 years.

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http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Ftri.12716

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Alberto Reino Buelvas 

Médico Internista Nefrólogo

Onset and progression of de novo donor-specific anti-human leukocyte antigen antibodies after BK polyomavirus and preemptive immunosuppression reduction

Transplant Infectious Disease Onset and progression of de novo donor-specific anti-human leukocyte antigen antibodies after BK polyomavirus and preemptive immunosuppression reduction

Abstract

Background

BK polyomavirus (BKPyV) viremia/nephropathy and reduction in immunosuppression following viremia may increase the risk of alloimmune activation and allograft rejection. This study investigates the impact of BKPyV viremia on de novo donor anti-human leukocyte antigen (HLA)-specific antibodies (dnDSA).

Patients and methods

All primary renal transplants at East Carolina University from March 1999 to December 2010, with at least 1 post-transplant BKPyV viral load testing, were analyzed. Patients were negative for anti-HLA antibodies to donor antigens (tested via single antigen beads) at transplantation and at first BKPyV testing.

Results

Nineteen of 174 patients (11%) tested positive for BKPyV viremia. Within 24 months of BKPyV viremia detection, 79% of BKPyV viremic patients developed dnDSA. Only 20% of BKPyV viremia-persistent cases, compared to 86% of BKPyV viremia-resolved cases, developed dnDSA (P = 0.03). Poor allograft survival was evident in BKPyV viremia-persistent patients (60% failure by 2 years post BKPyV diagnosis) and in BKPyV viremia-resolved patients with dnDSA (5-year post BKPyV diagnosis allograft survival of 48%).

Conclusions

Post-transplant BKPyV viremia and preemptive immunosuppression reduction is associated with high rates of dnDSA. When preemptively treating BKPyV viremia, dnDSA should be monitored to prevent allograft consequences.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Ftid.12467

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Alberto Reino Buelvas 

Médico Internista Nefrólogo

The incidence and risk factors of deep vein thrombosis after kidney transplantation in Korea: single center experience

Clinical Transplantation The incidence and risk factors of deep vein thrombosis after kidney transplantation in Korea: single center experience

Abstract

Background

The incidence of deep vein thrombosis (DVT) after kidney transplantation (KT) and the risk factors are still unknown in Korean patients. Determining the need for appropriate DVT prophylaxis is difficult when considering the low incidence of DVT in the Asian population. The aim of the present study was to investigate the incidence of DVT occurring 3 months after KT, the DVT occurrence pattern, and risk factors in Korean patients.

Methods

Data from a total of 393 patients who underwent KT from November 2009 to December 2012 were analyzed. Color duplex ultrasonography was used for the diagnosis or screening of DVT in all patients preoperatively and on postoperative day 7, 14, 28 and 90.

Results

The cumulative 3 months incidence of DVT after KT was 4.6%, and there was one symptomatic DVT. Patients with DVT were older than those without DVT at the time of transplantation (52.8 vs. 44.6, P < 0.001). According to univariate and multivariate analysis, older age was identified as a risk factor of DVT at the time of transplantation, whereas history of DVT did not reach statistical significance. There were no deaths related to DVT or pulmonary embolism.

Conclusions

Pharmacological prophylaxis after KT is not necessary because of the low incidence of DVT in Korean patients, and instead, we suggest that long-term mechanical prophylaxis of at least 3 months can be a suitable option. Patients older than 50 years of age have a higher risk of developing DVT, and careful observation is needed in these patients.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12648

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Alberto Reino Buelvas 

Médico Internista Nefrólogo

Allograft Nephrectomy versus No-Allograft Nephrectomy for Renal Transplantation: A Meta –Analysis

Clinical Transplantation Allograft Nephrectomy versus No-Allograft Nephrectomy for Renal Transplantation: A Meta –Analysis

Abstract

Objective

To assess the safety and efficacy of allograft nephrectomy vs no-allograft nephrectomy for renal re-transplantation.

Methods: Medline (PubMed), Embase, Ovid, Cochrane, and the Chinese Biomedical Literature databases were searched to identify clinically comparable trials which compared allograft nephrectomy(AN) and no-allograft nephrectomy(no-AN) with renal re-transplantation. RevMan 5.1 software and Stat Manager V4.1 software were used for the meta-analysis.

Results

Eight trials were included involving 1008 patients. Of these, 508 (50.4%) patients underwent AN and 500 (49.6%) had not undergone AN before re-transplantation. The pooled results revealed that the AN group had a longer time interval between graft loss and re-transplantation of 14.40 months (weighted mean difference (WMD) = 11.23; 95% confidence interval (CI): 2.47 to 19.99; P = 0.01). The AN group also had an higher rate of positive PRA (PRA>10%) before re-transplantation (OR: odds ratio =1.62, 95%CI=1.17-2.23, P=0.003). A comparison of serum creatinine (mg/dL) at one year after re-transplantation between the groups showed no significant differences (WMD: −0.25; 95%CI: −0.52–0.03; P = 0.08). There were neither significant differences in one-year graft survival rates (OR: 0.74; 95% CI: 0.31–1.72; P = 0.48) nor one-year patient survival rates (OR: 1.60; 95%CI: 0.57–4.46; P = 0.37) between the groups. Insignificant differences were noted for the rates of acute rejection (OR: 1.30; 95%CI: 0.89 to 1.91; P = 0.17) and postoperative complications (OR: 1.51; 95%CI: 0.24–9.43; P = 0.66) for the groups.

Conclusion

Through our meta-analysis, allograft nephrectomy before re-transplantation seemed well tolerated but conferred no significant benefit. The risk benefit ratio of transplant nephrectomy with re-transplantation must be evaluated in each individual patient.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12654

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Alberto Reino Buelvas 

Médico Internista Nefrólogo