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Differential risks for adverse outcomes 3 years after kidney transplantation based on initial immunosuppression regimen: a national study.
Transpl Int
November 2016
Saint Louis University School of Medicine, Saint Louis, MO, USA.
We examined integrated national transplant registry, pharmacy fill, and medical claims data for Medicare-insured kidney transplant recipients in 2000-2011 (n = 45 164) from the United States Renal Data System to assess the efficacy and safety endpoints associated with seven early (first 90 days) immunosuppression (ISx) regimens. Risks of clinical complications over 3 years according to IS regimens were assessed with multivariate regression analysis, including the adjustment for covariates and propensity for receipt of a nonreference ISx regimen. Compared with the reference ISx (thymoglobulin induction with tacrolimus, mycophenolate, and prednisone maintenance), sirolimus-based ISx was associated with significantly higher three-year risks of pneumonia (adjusted hazard ratio, aHR 1.
View Article and Find Full Text PDFVariation in Comedication Use According to Kidney Transplant Immunosuppressive Regimens: Application of Integrated Registry and Pharmacy Claims Data.
Transplant Proc
October 2016
Washington University, St Louis, Missouri.
Background: Modern immunosuppression therapies (ISx) have many side effects, and transplant recipients must take an array of "comedications" to help mitigate complications. Comedication use patterns are not well described in large, representative samples because of lack of data.
Methods: We integrated national U.
The risk of recurrent IgA nephropathy in a steroid-free protocol and other modifying immunosuppression.
Clin Transplant
August 2014
Division of Nephrology, Department of Internal Medicine, The Ohio State University College of Medicine and Public Health, Columbus, OH, USA.
Recurrent glomerulonephritis is an important cause of kidney allograft failure. The effect of immunosuppression on recurrent IgA nephropathy (IgAN) is unclear. We analyzed the impact of steroids and other immunosuppression on the risk of recurrent IgAN post-kidney transplantation.
View Article and Find Full Text PDFCalcineurin inhibitor avoidance versus steroid avoidance following kidney transplantation: Postoperative complications.
Transplant Proc
December 2006
Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4750, USA.
This study compared early postoperative complications in kidney transplant recipients treated with either a sirolimus-based calcineurin inhibitor (CNI)-free regimen or a tacrolimus-based steroid-free regimen. We used a single-center, prospective, sequential but nonrandomized study design. Consecutive recipients of primary cadaveric or non-HLA identical kidney transplant recipients received either a CNI-free regimen, consisting of sirolimus 5 mg daily beginning postoperative day 3, mycophenolate mofetil 1 gm twice a day, and methylprednisolone 500 mg intraoperatively, then prednisone 30 mg daily tapered to 10 mg daily at 3 months, or a prednisone-free regimen, consisting of methylprednisolone 500 mg, 250 mg, and 125 mg from days 0 to 2, then no further steroids, tacrolimus 0.
View Article and Find Full Text PDFImmunosuppression for islet transplantation.
Acta Med Okayama
April 2006
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
The development by the Edmonton group of a sirolimus-based, steroid-free, low-tacrolimus regimen is a significant breakthrough that allows the rate of insulin independence after islet transplantation to increase from 13% to 80% at 1 year; however, the rate is reduced to 50% at 3 years, attributed to prolonged tacrolimus exposure. Recently, immunosuppression agents such as cyclosporine, mycophenolate mofetil, and the novel agent FTY 720 have been used instead of tacrolimus. Lymphocyte-depleting antibodies such as anti-thymocyte globulin, alemtuzumab, and hOKT3gamma 1 (ala, ala) have been launched, and a costimulatory blockade of anti-CD40 monoclonal antibodies and CTLA4-Ig will be attempted in the near future.
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