Higher recurrence of NASH and CC was associated with presence of MS, HTN and insulin use. Recurrence should be further evaluated in larger studies, with special emphasis on management of MS and prevention strategies.
Background: The safety profiles of standard therapy versus everolimus with reducedexposure calcineurin inhibitor (CNI) therapy using contemporary protocols in de novo kidney transplant recipients have not been compared in detail.Methods: TRANSFORM was a randomized, international trial in which de novo kidney transplant patients were randomized to everolimus with reduced-exposure CNI (N=1014) or mycophenolic acid (MPA) with standard-exposure CNI (N=1012), both with induction and corticosteroids.Results: Within the safety population (everolimus 1014, MPA 1012), adverse events with a suspected relation to study drug occurred in 62.9% versus 59.2% of patients given everolimus or MPA, respectively (p=0.085). Hyperlipidemia, interstitial lung disease, peripheral edema, proteinuria, stomatitis/mouth ulceration, thrombocytopenia and wound healing complications were more frequent with everolimus, while diarrhea, nausea, vomiting, leukopenia, tremor and insomnia were more frequent in the MPA group. The incidence of viral infections (17.2% versus 29.2%; p<0.001), CMV infections (8.1% versus 20.1%; p<0.001), CMV syndrome (13.6% versus 23.0%, p=0.044) and BKV infections (4.3% versus 8.0%, p<0.001) were less frequent with everolimus. CMV infection was less common with everolimus versus MPA after adjusting for prophylaxis therapy in the D+/R-subgroup (p<0.001). Study drug was discontinued more frequently due to rejection or impaired healing with everolimus, and more often due to BKV infection or BKV nephropathy with MPA.
Conclusion.De novo everolimus with reduced-exposure CNI yielded a comparable incidence, though a distinctly different pattern, of adverse events versus current standard-ofcare. Both regimens are safe and effective, yet their distinct profiles may enable tailoring for individual kidney transplant recipients.
Little is known about the use of histidine-tryptophan-ketoglutarate (HTK) preservation solution for pancreas preservation. We compared early pancreas graft outcomes at four pancreas transplant programs within the state of Michigan in 2002 and 2003 (University of Wisconsin [UW] era) with those in 2004 (HTK era). The primary endpoint was early graft loss. The UW group (n=41) and the HTK group (n=36) had similar outcomes with respect to: technical graft loss (9.8% vs. 8.3%, P=NS), 90-day graft function (90.2% vs. 86.1%, P=NS), and rate of pancreatic leak/abscess (12.2% vs. 11.1%, P=NS). There were also no significant differences in postoperative amylase and lipase levels between the two groups. The HTK group did have significantly more acute rejection within the first 180 days (25.0% vs. 9.8%, P<0.05). HTK is a suitable substitute for UW in the preservation of pancreas allografts.
Summary
Since 1998, our institution has routinely accepted livers from deceased donors older than 70 years for transplantation. The aim of this study was to determine whether these older donor livers should be used in a routine manner. Twenty‐five patients received livers from older donors between 1998 and 2002. Older donor liver recipients’ actuarial survival was 95.4% at 1 year and 89.8% at 3 years. Graft survivals were 82.7% at 1 year and 71.7% at 3 years. Five older donor liver recipients with hepatitis C had worse patient survival (80% at 1 year and 40% at 3 years) and graft survival (80% at 1 year and 20% at 3 years). In conclusion, use of livers from deceased older donors affords excellent patient and graft survival, comparable with results achieved with younger donor organs. However, use of older donor livers for patient with hepatitis C may result in worse outcome.
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