Patient survival after renal transplantation; more than 25 years follow-up

Arend, Sandra M.; Mallat, M.; Westendorp, R.; Woude, Fokko J. van der; Es, L. A. Van

doi:10.1093/ndt/12.8.1672

Cited by 196 publications

(115 citation statements)

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“…Long-term graft survival, excluding patient death as a cause of graft failure, is primarily influenced by the occurrence of chronic rejection with subsequent development of renal failure (12,13). The reduced survival of kidney transplantation patients is largely a result of the high risk of cardiovascular disease and malignancies in this population (14).…”

Section: Discussionmentioning

confidence: 99%

Withdrawal of Cyclosporine or Prednisone Six Months after Kidney Transplantation in Patients on Triple Drug Therapy

Gregoor¹,

Sévaux

Ligtenberg

et al. 2002

Journal of the American Society of Nephrology

141

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ABSTRACT. Uncertainty exists regarding the necessity of continuing triple therapy consisting of mycophenolate mofetil (MMF), cyclosporine (CsA), and prednisone (Pred) after kidney transplantation (RTx). At 6 mo after RTx, 212 patients were randomized to stop CsA (n = 63), stop Pred (n = 76), or continue triple drug therapy (n = 73). The MMF dose was 1000 mg twice daily, target CsA trough levels were 150 ng/ml, and Pred dose was 0.10 mg/kg per d. Follow-up was until 24 mo after RTx. Biopsy-proven acute rejection occurred in 14 (22%) of 63 patients after CsA withdrawal compared with 3 (4%) of 76 in the Pred withdrawal group (P = 0.001) and 1 (1.4%) of 73 in the control group (P = 0.0001). Biopsy-proven chronic rejection was present in one patient in the control group, in nine patients after CsA withdrawal (P = 0.006 versus control group); and in four patients after discontinuation of Pred (NS). Graft loss occurred in two versus one patient after CsA or Pred withdrawal, respectively, and in two patients in the control group (NS). Patients who successfully withdrew CsA had a significantly lower serum creatinine during follow-up. Pred withdrawal resulted in a reduction in mean arterial pressure, and the total cholesterol/HDL ratio increased. In conclusion, rapid CsA withdrawal at 6 mo after RTx results in a significantly increased incidence of biopsy-proven acute and chronic rejection. Pred withdrawal was safe and resulted in a reduction in mean arterial pressure. However, patient and graft survival and renal function 2 yr after RTx were not different among groups.

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Section: Discussionmentioning

confidence: 99%

Withdrawal of Cyclosporine or Prednisone Six Months after Kidney Transplantation in Patients on Triple Drug Therapy

Gregoor¹,

Sévaux

Ligtenberg

et al. 2002

Journal of the American Society of Nephrology

141

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“…Therefore, it is of major importance to optimize graft survival. Furthermore, patient survival of renal transplant recipients (RTR) is significantly lower compared to the general population 4. In spite of previous developments, in the past 2 decades, there was only little improvement in long‐term graft and patient survival after renal transplantation 5.…”

Section: Introductionmentioning

confidence: 99%

Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients

Osté

Gomes-Neto

Corpeleijn

et al. 2018

American Journal of Transplantation

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Renal transplant recipients (RTR) are at risk of decline of graft function and premature mortality, with high blood pressure as an important risk factor for both. To study the association of the Dietary Approach to Stop Hypertension (DASH) diet with these adverse events, we conducted a prospective cohort study of adult RTR. Dietary data were collected using a validated 177‐item food frequency questionnaire and an overall DASH‐score was obtained. We included 632 stable RTR (mean ± standard deviation age 53.0 ± 12.7 years, 57% men). Mean DASH score was 23.8 ± 4.7. During median follow‐up of 5.3 (interquartile range, 4.1‐6.0) years, 119 (18.8%) RTR had renal function decline, defined as a combined endpoint of doubling of serum creatinine and death‐censored graft failure, and 128 (20.3%) died. In Cox‐regression analyses, RTR in the highest tertile of the DASH score had lower risk of both renal function decline (hazard ratio [HR] = 0.57; 95% confidence interval [CI], 0.33‐0.96, P = .03) and all‐cause mortality (HR = 0.52; 95%CI, 0.32‐0.83, P = .006) compared to the lowest tertile, independent of potential confounders. Adherence to a DASH‐style diet is associated with lower risk of both renal function decline and all‐cause mortality. These results suggest that a healthful diet might benefit long‐term outcome in RTR.

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“…Kidney transplantation offers a survival advantage over dialysis treatment in essentially all patient subgroups 1,2 ; however, the survival of kidney transplant recipients (KTR) is inferior to that of the general population. 3 Although early kidney dysfunction has a clear adverse effect on long-term allograft survival, there are fewer data on the relationship between early graft function and patient survival. In a retrospective study of 589 recipients of first deceased-donor allografts, mortality was significantly increased in patients with a primary nonfunction (i.e., a graft that never functions) compared with those with less severe graft dysfunction (45 versus 20% at 6 yr) 4 ; however, there was no significant difference in survival among patients with delayed graft function (DGF) versus immediate graft function.…”

mentioning

confidence: 99%

Delayed Graft Function and the Risk for Death with a Functioning Graft

Tapiawala

Tinckam

Cardella

et al. 2010

Journal of the American Society of Nephrology

179

137

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Delayed graft function (DGF) associates with an increased risk for graft failure, but its link with death with graft function (DWGF) is unknown. We used the US Renal Data System to assemble a cohort of all first, adult, deceased-donor kidney transplant recipients from January 1, 1998, through December 31, 2004. In total, 11,542 (23%) of 50,246 recipients required at least one dialysis session in the first week after transplantation. Compared with patients without DGF, patients with DGF were significantly more likely to die with a functioning graft (relative hazard 1.83 [95% confidence interval 1.73 to 1.93] and 1.53 [95% CI 1.45 to 1.63] for unadjusted and fully adjusted models, respectively). The risk for DWGF was slightly higher among women with DGF than among men. There was no significant heterogeneity among other subgroups, and the results were robust to sensitivity analyses. Acute rejection within the first year attenuated the DGF-DWGF association. Cardiovascular and infectious deaths were slightly more prevalent in the DGF group, but the relative hazards of cause-specific death were similar between DWGF and deaths during total follow-up. In summary, DGF associates with an increased risk for DWGF; the mechanisms underlying the negative impact of DGF require further study.

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Patient survival after renal transplantation; more than 25 years follow-up

Cited by 196 publications

References 0 publications

Withdrawal of Cyclosporine or Prednisone Six Months after Kidney Transplantation in Patients on Triple Drug Therapy

Withdrawal of Cyclosporine or Prednisone Six Months after Kidney Transplantation in Patients on Triple Drug Therapy

Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients

Delayed Graft Function and the Risk for Death with a Functioning Graft

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