ABSTRACT
OBJECTIVES: There is no consensus on the best immunosuppressive regimen for elderly renal transplant recipients. The objective of this study was to assess cytomegalovirus infection incidence and kidney transplant outcomes in elderly recipients treated with mammalian target of rapamycin inhibitors sirolimus/ tacrolimus at low doses compared with those receiving tacrolimus/mycophenolate sodium. MATERIALS AND METHODS: In this single-center prospective randomized study (Trial Registration No. NCT02683291), kidney transplant recipients over 60 years of age were randomly allocated into 2 groups: tacrolimus-sirolimus (21 patients) and tacrolimus-mycophenolate (23 patients). Cytomegalovirus infection rate and patient survival, biopsy-proven acute rejection, and renal function at 12 months were assessed. RESULTS: Cytomegalovirus infection rate was higher in the mycophenolate group (60.9%) than in the sirolimus group (16.7%; P = .004). The rates of biopsy-proven acute rejection, patient survival, graft survival, and estimated glomerular filtration rate over 12 months did not significantly differ between groups. CONCLUSIONS: The incidence of cytomegalovirus infection was significantly lower in the sirolimus group. The use of tacrolimus combined with sirolimus in elderly kidney transplant recipients is safe.
Subject(s)
Calcineurin Inhibitors/administration & dosage , Immunosuppressive Agents/administration & dosage , Kidney Transplantation , Sirolimus/administration & dosage , Tacrolimus/administration & dosage , Age Factors , Aged , Biopsy , Brazil/epidemiology , Calcineurin Inhibitors/adverse effects , Cytomegalovirus Infections/epidemiology , Cytomegalovirus Infections/immunology , Drug Therapy, Combination , Female , Glomerular Filtration Rate , Graft Rejection/epidemiology , Graft Rejection/immunology , Graft Survival , Humans , Immunosuppressive Agents/adverse effects , Incidence , Kidney Transplantation/adverse effects , Male , Middle Aged , Prospective Studies , Risk Factors , Sirolimus/adverse effects , Tacrolimus/adverse effects , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: No safe ultrasound (US) parameters have been established to differentiate the causes of graft dysfunction. OBJECTIVES: To define US parameters and identify the predictors of normal graft evolution, delayed graft function (DGF), and rejection at the early period after kidney transplantation. METHODS: Between June 2012 and August 2013, 79 renal transplant recipients underwent US examination 1-3 days posttransplantation. Resistive index (RI), power Doppler (PD), and RI + PD (quantified PD) were assessed. Patients were allocated into three groups: normal graft evolution, DGF, and rejection. RESULTS: Resistive index of upper and middle segments and PD were higher in the DGF group than in the normal group. ROC curve analysis revealed that RI + PD was the index that best correlated with DGF (cutoff = 0.84). In the high RI + PD group, time to renal function recovery (6.33 ± 6.5 days) and number of dialysis sessions (2.81 ± 2.8) were greater than in the low RI + PD group (2.11 ± 5.3 days and 0.69 ± 1.5 sessions, respectively), p = 0.0001. Multivariate analysis showed that high donor final creatinine with a relative risk (RR) of 19.7 (2.01-184.7, p = 0.009) and older donor age (RR = 1.17 (1.04-1.32), p = 0.007) correlated with risk DGF. CONCLUSIONS: Quantified PD (RI + PD) was the best DGF predictor. PD quantification has not been previously reported.
