A calcineurin antagonist‐free induction/maintenance strategy for immunosuppression in elderly recipients of renal allografts from elderly cadaver donors: long‐term results from a prospective single centre trial*

Arbogast, Helmut; Hückelheim, Henning; Schneeberger, H.; Illner, W.; Tarabichi, Anwar; Fertmann, Jan; Wimmer, Cornelius; Hillebrand, G.; Mistry‐Burchardi, Nouhad; Thomae, Robert; Açıkgöz, Ali; Land, W.

doi:10.1111/j.1399-0012.2005.00309.x

Cited by 31 publications

(20 citation statements)

References 14 publications

(13 reference statements)

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“…Acute rejection episodes occurred in 23.6% of patients. Long-term allograft function was satisfactory as reflected by serum creatinine values of 1.53 mg/dL and blood urea nitrogen values of 57.9 mg /dL at 5 years (30). These outcomes are comparable to those obtained in younger recipients on CsA-based regimens who have received allografts from young cadaveric donors.…”

Section: Cni Avoidance Regimenssupporting

confidence: 65%

“…Two uncontrolled studies evaluated specific populations believed to be at high risk for CNI-associated nephrotoxicity (18,29,30). In one study, all patients received kidneys that were from suboptimal donors (age Ն50 years, non-heart beating, arterial hypertension, acute renal failure) or that had a cold ischemia time of 24 hr or more (18).…”

Section: Cni Avoidance Regimensmentioning

confidence: 99%

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Toxicity-Sparing Protocols Using Mycophenolate Mofetil in Renal Transplantation

Land

Vincenti²

2005

Transplantation

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The introduction of triple-therapy regimens that include a calcineurin inhibitor (CNI), steroids, and azathioprine greatly reduced the risk of acute rejection in renal transplantation. However, the long-term use of both CNIs and steroids is associated with serious toxicities that ultimately can impact patient/graft survival. Mycophenolate mofetil (MMF), a highly effective immunosuppressant with no known nephrotoxicity, has been shown to provide benefits in preserving long-term renal allograft function relative to azathioprine. For these reasons, MMF has become an integral component of toxicity-sparing maintenance regimens that seek to minimize patient exposure to CNIs and steroids. This paper provides an overview of current strategies for reducing the toxicities associated with these agents, which include both withdrawal and avoidance regimens with or without induction therapy. Data are accumulating that toxicity-sparing regimens involving MMF are safe and decrease the risk of side effects that accompany the use of CNIs and steroids. Future studies will determine how to best implement these regimens in the renal transplant population.

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Section: Cni Avoidance Regimenssupporting

confidence: 65%

Section: Cni Avoidance Regimensmentioning

confidence: 99%

Toxicity-Sparing Protocols Using Mycophenolate Mofetil in Renal Transplantation

Land

Vincenti²

2005

Transplantation

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“…Arbogast et al [111] used a calcineurin-inhibitor-free protocol after induction with 4-10 days of rabbit anti-thymocyte globulin followed by MMF and corticosteroids in 89 recipients with a mean age of 64 years who received ECD kidneys with a mean donor age of 67 years. Cumulative 5-year patient and allograft survival results were excellent (88% and 70%, respectively), as was graft function (mean serum creatinine 1.5 mg/dl at 5 years).…”

Section: Maintenance Immunosuppressionmentioning

confidence: 99%

Renal transplantation in the elderly

Saxena

Yu²,

Giraldo

et al. 2008

Int Urol Nephrol

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Elderly patients are increasingly being considered for kidney transplantation due to a global explosion of the aging population with end-stage renal disease (ESRD). However, mounting scarcity of available organs for transplant has led to a wider disparity between organ supply and demand. Consequently, the criteria for accepting kidneys for transplantation have been extended in an attempt to allow the use of organs from elderly donors or those with significant co-morbidities, so-called "expanded criteria donor" (ECD) kidneys. Excellent outcomes have been achieved from ECD kidneys with appropriate donor and recipient profiling and selection. With increasing recovery efforts directed at older donors, the concept of age-matching is becoming more accepted as a method of optimizing utilization of organs in elderly donors and recipients. Utilization of pulsatile perfusion has further improved ECD outcomes and helped the decision-making process for the UNOS (United Network for Organ Sharing) offer. However, age-related immune dysfunction and associated co-morbidities make the elderly transplant recipients ever more susceptible to complications associated with immunosuppressive agents. Consequently, the elderly population is at a higher risk to develop infections and malignancy in the post-transplant period notwithstanding improved transplant outcomes. Appropriate immunosuppressive agents and dosages should be selected to minimize adverse events while reducing the risk of acute rejections and maximizing patient and renal allograft survival.

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“…Arbogast et al (28) investigated a therapeutic regimen consisting of a CNI free, mycophenolate mofetil-based immunosuppressive induction/maintenance protocol in 89 patients who received an organ from an elderly donor. Cumulative 5-year patient and graft survival was excellent with 88% and 70%, respectively, but only a historical control group under CNI therapy was available for comparison.…”

Section: Discussionmentioning

confidence: 99%