Predicting Glomerular Filtration Rate After Kidney Transplantation

Nankivell, Brian J.; Gruenewald, Simon M.; Allen, Richard D.; Chapman, Jeremy R.

doi:10.1097/00007890-199506270-00007

Cited by 271 publications

(168 citation statements)

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“…As additional parameters, we considered graft function evaluated by serum creatinine (sCr), creatinine clearance (Nankivell formula) (18), and 24-h proteinuria at 24 mo and changes in the degree of histologic CAN lesions. Moreover, we evaluated in the two groups of patients the expression of ␣-SMA in renal allograft biopsy at time of CAN diagnosis and after 2 yr as a surrogate marker of damage progression.…”

Section: Outcome Measuresmentioning

confidence: 99%

Rapamycin for Treatment of Chronic Allograft Nephropathy in Renal Transplant Patients

Stallone

Infante

Schena³

et al. 2005

Journal of the American Society of Nephrology

112

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Chronic allograft nephropathy (CAN) represents the main cause of renal allograft loss after 1 yr of transplantation. Calcineurin inhibitor (CNI) use is associated with increased graft expression of profibrotic cytokines, whereas rapamycin inhibits fibroblast proliferation. The aim of this randomized, prospective, open-label, single-center study was to evaluate the histologic and clinical effect of rapamycin on biopsy-proven CAN. Eighty-four consecutive patients who had biopsy-proven CAN and received a transplant were randomized to receive either a 40% CNI reduction plus mycophenolate mofetil (group 1; 50 patients) or immediate CNI withdrawal and rapamycin introduction with a loading dose of 0.1 mg/kg per d and a maintaining dose aiming at through levels of 6 to 10 ng/ml (group 2; 34 patients). The follow-up period was 24 mo. At the end of follow-up, 25 patients (group 1, 10 patients; group 2, 15 patients) underwent a second biopsy. CAN lesions were graded according to Banff criteria. ␣-Smooth muscle actin (␣-SMA) protein expression was evaluated in all biopsies as a marker of fibroblast activation. Graft function and Banff grading were superimposable at randomization. Graft survival was significantly better in group 2 (P ‫؍‬ 0.0376, 2 ‫؍‬ 4.323). CAN grading worsened significantly in group 1, whereas it remained stable in group 2. After 24 mo, all group 1 biopsies showed an increase of ␣-SMA expression at the interstitial and vascular levels (P < 0.001); on the contrary, ␣-SMA expression was dramatically reduced in group 2 biopsies (P ‫؍‬ 0.005). This study demonstrates that rapamycin introduction/CNI withdrawal improves graft survival and reduces interstitial and vascular ␣-SMA expression, slowing down the progression of allograft injury in patients with CAN.

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Section: Outcome Measuresmentioning

confidence: 99%

Rapamycin for Treatment of Chronic Allograft Nephropathy in Renal Transplant Patients

Stallone

Infante

Schena³

et al. 2005

Journal of the American Society of Nephrology

112

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“…Inclusion criteria were patients who were Ͼ1 yr after transplant and had impaired glucose tolerance or diabetes defined according to 1999 World Health Organization specifications (15) and an estimated GFR (eGFR) Ͼ25 ml/min using the Nankivell formula (16). All eligible patients gave informed consent to participate in the study, which was approved by the Human Ethics Committee of the University of Queensland and Princess Alexandra Hospital.…”

Section: Study Design and Populationmentioning

confidence: 99%

Cardiorespiratory Fitness Is Related to Physical Inactivity, Metabolic Risk Factors, and Atherosclerotic Burden in Glucose-Intolerant Renal Transplant Recipients

Armstrong¹,

Rakhit²,

Jeffriess³

et al. 2006

Clinical Journal of the American Society of Nephrology

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The mechanisms of reduced cardiorespiratory fitness (CF) in renal transplant recipients (RTR) have not been studied closely. This study evaluated the relationships between CF and specific cardiovascular risk factors (metabolic syndrome [MS], physical inactivity, myocardial ischemia, and atherosclerotic burden) in glucose-intolerant RTR. Data were recorded on 71 glucose-intolerant RTR (mean age 55 yr; 55% male; median transplant duration 5.7 yr). MS was defined using National Cholesterol Education Programme Adult Treatment Panel III criteria. Resting and exercise stress echocardiography were performed, and myocardial ischemia was identified by new or worsening wall motion abnormalities. Cardiorespiratory fitness was determined using peak oxygen uptake (VO 2 ) by expired gas analysis. Atherosclerotic burden was assessed by carotid intima-media thickness (IMT). Mean peak VO 2 was 19 ؎ 7 ml/kg per min and was significantly lower than predicted peak VO 2 (29 ؎ 6 ml/kg per min; P < 0.001). Patients with MS (63%) had reduced CF (17 ؎ 6 versus 22 ؎ 8 ml/kg per min; P ‫؍‬ 0.001) and were more likely to be physically inactive (76 versus 48%; P ‫؍‬ 0.02). CF was reduced in 14 patients with myocardial ischemia (15 ؎ 3 versus 20 ؎ 7 ml/kg per min; P ‫؍‬ 0.05). CF was positively correlated with male gender, height, and physical activity and inversely correlated with number of MS risk factors and IMT (adjusted R 2 ‫؍‬ 0.66). Carotid IMT added incremental value to clinical variables in determining VO 2 (adjusted R 2 ‫؍‬ 0.65 versus 0.63; P ‫؍‬ 0.04). Reduced CF is associated with physical inactivity, MS, and atherosclerotic burden in glucose-intolerant RTR. Further studies should address whether increasing exercise and modifying MS risk factors improve CF in RTR.

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“…Kidney graft function was evaluated by sCr and creatinine clearance (Nankivell formula) at discharge, 3 mo, and at 1 yr posttransplantation (15).…”

Section: Kidney Functionmentioning

confidence: 99%

Addition of Sirolimus to Cyclosporine Delays the Recovery from Delayed Graft Function but Does not Affect 1-Year Graft Function

Stallone

Paolo²,

Schena³

et al. 2004

Journal of the American Society of Nephrology

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Predicting Glomerular Filtration Rate After Kidney Transplantation

Cited by 271 publications

References 0 publications

Rapamycin for Treatment of Chronic Allograft Nephropathy in Renal Transplant Patients

Rapamycin for Treatment of Chronic Allograft Nephropathy in Renal Transplant Patients

Cardiorespiratory Fitness Is Related to Physical Inactivity, Metabolic Risk Factors, and Atherosclerotic Burden in Glucose-Intolerant Renal Transplant Recipients

Addition of Sirolimus to Cyclosporine Delays the Recovery from Delayed Graft Function but Does not Affect 1-Year Graft Function

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