ABSTRACT
PURPOSE: CD25 monoclonal antibody (basiliximab, BA) has been reported an excellent effect on induction immunosuppression than ALG, ATG, OKT3 in renal transplantation. Since we can use BA only in the group of high risk kidney recipient, we want to evaluate the effect of BA treated group by comparing with conventional 3 drugs combination group (calcineurin inhibitor/cyclosporine or tacrolimus, mycophenolate mofetil and prednisolon). METHODS: Total 103 recipients were treated by BA and conventional 3 drugs from March 2000 through February 2006, and these cases were compared with 122 recipients without BA. Government guidelines for using BA were in cadaveric transplantation, more than 4 HLA mismatching, zero DR antigen matching, retransplantation and more than 80% positive PRA. The episode of acute rejection (AR), steriod resistant acute rejection, change of serum creatinine, maintaining dosage of calcineurin inhibitor (CNI) and other side effects were compared between groups. RESULTS: The rate of AR within 12 months after transplantation was 11.7% in BA group while 9.0% in control group (P=0.451). The steroid resistant acute rejection was 16.6% in BA group and 27.3% in control group (P=0.119). Rejection free graft survival adjusted various clinical risk factors by Cox-regression test were no significance between groups. Serum creatinine level at one year after transplantation was 1.61+/-.1 and 1.46+/-.7 mg/dL in BA and control group, and recipients number whose SCr over 1.5 mg/dL were 39.0% and 32.7% (P=0.326). Cyclosporin dosage at one year in BA and control group were 4.21 and 3.62 mg/kg (P=0.202) and 0.11 and 0.17 mg/kg in tacrolimus group (P=0.291). Incidence of PTDM and viral infection were all no difference statistically between groups. CONCLUSION: In conclusion, BA induction immunosuppression with CNI, mycophenolate mofetil and prednisolon used in high risk kidney recipient effectively control the acute rejection and steroid resistant acute rejection for one year at least the same as control group. But since there was no more beneficial effect in BA added to Tac group than conventional Tac based immunosuppression, this 4 drug combination is better avoided if possible.
Subject(s)
Cadaver , Calcineurin , Creatinine , Cyclosporine , Graft Survival , Immunosuppression Therapy , Incidence , Kidney Transplantation , Kidney , Muromonab-CD3 , Risk Factors , Tacrolimus , TransplantationABSTRACT
Purpose: Kidney transplantation (KT) is one of the important treatment modality for the patients with focal segmental glomerulosclerosis (FSGS), but high recurrence rate and resulting graft failure is still a great obstacle. In order to compare the results of transplantation for recipient with FSGS, we reviewed our cases retrospectively. Methods: Thirty-six biopsy proven FSGS were reviewed and compared their clinical characteristics according to their recurrence status, retrospectively. Patient with significant proteinuria after KT was re-biopsied and light- and electron-microscopic study were done to confirm the recurrence of original disease. Results: Recurrence of FSGS was confirmed histologically in 13 (36%) recipients. Among 15 failed grafts, 9 grafts lost their function by recurrence of FSGS. Higher rate of acute rejection associated in recurred group (53% vs 39%). Five-year graft survival of recurred group was significantly lower than non-recurred group (65% vs 78%, P=0.0071). Cyclosporin group showed more frequent recurrence of FSGS after transplantation than tacrolimus group but no statistical significance (P>0.05). Plasmapheresis (PP) was done in 8 patients with early recurred FSGS and was effective in reducing the grade of proteinuria. Their long-term graft survival, however, was poor even though half of the recurred patients maintain their graft function until 5 years after PP. Conclusion: Our data showed that the recurred FSGS group showed higher rate of graft loss and poor graft survival. Since the FSGS recurrence is directly related with graft survival, large data analysis will be necessary to analyze the risk factor of recurrence and prevent adverse effect of recurrence of FSGS after KT.
Subject(s)
Humans , Biopsy , Cyclosporine , Glomerulosclerosis, Focal Segmental , Graft Survival , Kidney Transplantation , Kidney , Plasmapheresis , Proteinuria , Recurrence , Retrospective Studies , Risk Factors , Statistics as Topic , Tacrolimus , TransplantsABSTRACT
PURPOSE: The calcineurin inhibitors, tacrolimus and cyclosporine, have been used as primary immunosuppressant in renal transplantation. Tacrolimus has been shown to be an effective alternative to cyclosporine for the prevention of acute rejection but the two drugs are different in side-effect profile. This retrospective study compares the efficacy and safety of tacrolimus-based versus cyclosporine-based immunosuppression in patients receiving kidney transplantation. METHODS: There were 177 consecutive recipients of kidney graft; 90 received cyclosporine-based immunosuppression therapy, and 87 received tacrolimus-based immunosuppression. Graft and patient survival rate, incidence of acute rejection and side effects were compared. RESULTS: The 3-year graft survival rate of cyclosporine and tacrolimus was similar (93.0% vs. 91.4%). The incidence of acute rejection was significantly less in the tacrolimus group compared with the cyclosporine group (10.3% vs. 31.1%, P<0.05). Incidence of impaired renal function, gastrointestinal disorder, tremor, hypertension and hyperkalemia were comparable in both treatment groups. Higher incidence of posttransplant diabetes, allopecia, abdominal pain and headache was reported in the tacrolimus group, whereas that of hypercholesterolmeia, hirsuitism, and gum hyperplasia was more frequent with cyclosporine group. CONCLUSION: Tacrolimus is as effective as cyclosporine in patient and graft survival in kidney transplantation. Due to different side-effect profiles, it is needed to develop individualized immunosuppressive strategies in renal transplant recipients.