Early conversion to a sirolimus-based, calcineurin-inhibitor-free immunosuppression in the SMART trial: observational results at 24 and 36 months after transplantation

Early conversion to a sirolimus-based, calcineurin-inhibitor-free immunosuppression in the SMART trial: observational results at 24 and 36 months after transplantation:

Summary

Early conversion to a calcineurin-inhibitor (CNI)-free maintenance immunosuppression with sirolimus (SRL), mycophenolate mofetil (MMF) and steroids was associated with an improved 1-year renal function as compared with a cyclosporine (CsA)-based regimen (SMART core-study). This observational follow-up describes 132 patients followed up within the SMART study framework for 36 months. At 36 months, renal function continued to be superior in SRL-treated patients [ITT-eGFR_@36m: 60.88 vs. 53.72 (CsA) ml/min/1.73 m², P = 0.031].

Correction of Postkidney Transplant Anemia Reduces Progression of Allograft Nephropathy

Correction of Postkidney Transplant Anemia Reduces Progression of Allograft Nephropathy:
Retrospective studies suggest that chronic allograft nephropathy might progress more rapidly in patients with post-transplant anemia, but whether correction of anemia improves renal outcomes is unknown. An open-label, multicenter, randomized controlled trial investigated the effect of epoetin-β to normalize hemoglobin values (13.0–15.0 g/dl, n=63) compared with partial correction of anemia (10.5–11.5 g/dl, n=62) on progression of nephropathy in transplant recipients with hemoglobin <11.5 g/dl and an estimated creatinine clearance (eCrCl) <50 ml/min per 1.73 m².

Mycophenolate mofetil in low-risk renal transplantation in patients receiving no cyclosporine: a single-centre experience

Mycophenolate mofetil in low-risk renal transplantation in patients receiving no cyclosporine: a single-centre experience: Background.
We assess our long-term experience with regards the safety and efficacy of Mycophenolate Mofetil (MMF) in our low risk renal transplant population and compared it retrospectively to Azathioprine (AZA) immunosuppressive regimen.
Patients and methods.
Between January 1999 and December 2005, 240 renal transplants received MMF as part of their immunosuppressive protocol (MMF group). AZA group of 135 renal transplants was included for comparative analysis (AZA group). Patients received Cyclosporine was excluded from this study.

Very early steroid withdrawal or complete avoidance for kidney transplant recipients: a systematic review

Very early steroid withdrawal or complete avoidance for kidney transplant recipients: a systematic review: Background.
The safety and efficacy of early steroid withdrawal or avoidance in patients receiving a kidney transplant (KT) are controversial.
Methods.
We performed a systematic review and a meta-analysis of the randomized controlled studies about steroid avoidance or withdrawal after a few days in patients receiving a KT and treated with antibody induction and cyclosporine (CsA) or tacrolimus (Tac) plus mycophenolate mofetil (MMF) (nine available studies and 1934 participants).

A Randomized Controlled Trial of Intravenous or Oral Iron for Posttransplant Anemia in Kidney Transplantation

A Randomized Controlled Trial of Intravenous or Oral Iron for Posttransplant Anemia in Kidney Transplantation: Background: Anemia after kidney transplantation has been associated with poor transplant outcomes. We hypothesized that intravenous (IV) iron may more rapidly correct anemia than oral (PO) iron.
Methods: One hundred four kidney transplant recipients were prospectively randomized to IV iron polymaltose (500 mg single dose) or PO ferrous sulfate (210 mg elemental iron daily, continuously). The primary outcome was time to resolution of anemia, defined as hemoglobin more than or equal to 11 g/dL. Secondary outcomes included infections, blood transfusions, gastrointestinal side-effects, and acute rejection.

A New Diagnostic Algorithm for Antibody-Mediated Microcirculation Inflammation in Kidney Transplants

A New Diagnostic Algorithm for Antibody-Mediated Microcirculation Inflammation in Kidney Transplants:

We studied the significance of microcirculation inflammation in kidney transplants, including 329 indication biopsies from 251 renal allograft recipients, who were mostly nonpresensitized (crossmatch negative). Glomerulitis (g) and peritubular capillaritis (ptc) were often associated with antibody-mediated rejection (65% and 75%, respectively), but were also found in other diseases in the absence of donor-specific antibody (DSA): T-cell-mediated rejection (ptc, g), glomerulonephritis (g) and acute tubular necrosis (ptc). To develop rules for reducing the nonspecificity of microcirculation inflammation and defining the best grading thresholds associated with DSA, we built and validated a decision tree to predict DSA.