The Change in Allograft Function among Long-Term Kidney Transplant Recipients

Gill, John S.; Tonelli, Marcello; Mix, Christian H.; Pereira, Brian J.G.

doi:10.1097/01.asn.0000070621.06264.86

Cited by 93 publications

(82 citation statements)

References 30 publications

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“…This is in contrast to the decline of 1 to 3 ml/min per 1.73 m 2 /yr typically CLINICAL RESEARCH www.jasn.org observed with standard-dosage calcineurin inhibitors (CNIs) 9,10 and is consistent with the renal benefit seen with belatacept in the original study at 1 year. 7 It should be noted that in our study, the GFR at the beginning of the LTE was similar in the belatacept and CsA groups, despite a difference in favor of belatacept at the end of the original study.…”

Section: Discussionsupporting

confidence: 65%

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Vincenti

Blancho

Dürrbach

et al. 2010

Journal of the American Society of Nephrology

175

139

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Belatacept is a first-in-class co-stimulation blocker in development for primary maintenance immunosuppression. A Phase II study comparing belatacept with cyclosporine (CsA) for prevention of acute rejection and protection of renal function in kidney transplant recipients demonstrated similar efficacy and significantly higher measured GFR at 1 year for belatacept, but the incidence of posttransplantation lymphoproliferative disorder was higher. Here, we present the results for the extension of this trial, which aimed to assess long-term safety and efficacy of belatacept. Seventy-eight of 102 patients who were receiving belatacept and the 16 of 26 who were receiving CsA completed the long-term extension period. GFR remained stable in patients who were receiving belatacept for 5 years, and the incidences of death/graft loss or acute rejection were low. The frequencies of serious infections were 16% for belatacept and 27% for CsA, and neoplasms occurred in 12% of each group. No patients who were treated with belatacept and one patient who was treated with CsA developed posttransplantation lymphoproliferative disorder during the follow-up period. Serious gastrointestinal disorders occurred more frequently with belatacept (12% belatacept versus 8% CsA), and serious cardiac disorders occurred more frequently with CsA (2% belatacept versus 12% CsA). Pharmacokinetic analyses showed consistent exposure to belatacept over time. CD86 receptor saturation was higher in patients who were receiving belatacept every 4 weeks (74%) compared with every 8 weeks (56%). In conclusion, this study demonstrated high patient persistence with intravenous belatacept, stable renal function, predictable pharmacokinetics, and good safety with belatacept over 5 years.

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Section: Discussionsupporting

confidence: 65%

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Vincenti

Blancho

Dürrbach

et al. 2010

Journal of the American Society of Nephrology

175

139

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“…Recently, it was proposed that all grafts loose function at a slow but steady rate. It was suggested that the strategies for improvement baseline graft function, defined as GFR at post-transplant month 6, might be more important for graft outcome than those for a slowly declining GFR (9). As graft function at the end of the early post-transplant period depends on the quality of the transplanted kidney and early post-transplant events (15,16), we decided to analyze the transplantation outcome of living related donor grafts which avoided AR and DGF.…”

Section: Discussionmentioning

confidence: 99%

“…In these studies kidney or graft function was most commonly estimated by creatinine clearance, as calculated by the Cockcroft-Gault formula, and the influence of donor factors was examined on graft function at multiple timepoints (3,7,8). Recently, several studies have evaluated the change of creatinine clearance in the post-transplant period and the influence of different factors on this continuous parameter (3,7,9).…”

Section: Introductionmentioning

confidence: 99%

Donor Kidney Glomerular Filtration Rate and Post-Transplant Graft Function

Ležaić¹,

Naumovic²,

Marinković³

et al. 2004

American Journal of Transplantation

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This study aimed to estimate the relationship between the single kidney glomerular filtration rate (SKGFR) of a planned kidney transplant and the subsequent graft function and survival of living related kidney recipients (LKRs). Of 180 LKRs with the graft functioning for more than a year, 70 patients without delayed graft function (DGF) or acute rejection (AR) were selected for the study. According to SKGFR, assessed by 99m TcDTPA, the patients were allocated into Group 1, receiving kidney with SKGFR < 50 mL/min (32 patients), and Group 2, with SKGFR > 50 mL/min (38 patients). The database included donor, recipient and transplant variables. No significant difference was found between the patient and graft survival rate, creatinine clearance (CCr) and the rate of CCr change between the groups. Additional evaluation revealed no significant influence of the ratio of SKGFR and the recipient's body weight/size on patient and graft outcome. The analysis of factors of influence on patient and graft survival and function revealed the major influence of nonimmunological factors but not of SKGFR of the transplanted kidney. Our study did not confirm the influence of SKGFR on graft function and survival in the LKRs without DGF and AR but the limited number of patients must not be disregarded.

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“…Whether 1, 5, or 10 years after transplantation, the GFR based on serum creatinine places the majority of patients into the stage 3T CKD (41). As seen in Figure 3, kidney function is reasonably stable over time with a slight trend toward a decrease over years as indicated by the slight shift to the left (42). Overall kidney function decreases, which translates into a Ϫ0.33 Ϯ 0.87 drop during the first 2 years and a Ϫ2.68 Ϯ 0.44 drop after that or approximately an overall Ϫ1.66 Ϯ 0.51 drop each year.…”

Section: Monitoringmentioning

confidence: 91%

Monitoring and Managing Graft Health in the Kidney Transplant Recipient

Josephson

2011

Clinical Journal of the American Society of Nephrology

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SummaryOngoing monitoring of kidney transplants is a widely accepted and practiced part of posttransplantation management. One reason to monitor is to evaluate whether the transplant is stable. The transplant community evaluates stability by checking kidney function. Despite problems with sensitivity and specificity, obtaining serial serum creatinine levels is the most common approach to assessing kidney function. Some programs supplement serial serum creatinine levels with surveillance kidney biopsies. Although not uniformly accepted as beneficial, surveillance biopsies are useful in select subsets of patients such as highly sensitized recipients. Recent biopsy studies shed light on which histopathology findings portend poor prognoses. The Long-Term Deterioration of Kidney Allograft Function Study (DeKAF) and similar studies that will prospectively evaluate therapeutic interventions should help the transplant community better define how to monitor and manage the kidney transplant optimally. In the meantime, Kidney Diseases: Improving Global Outcomes (KDIGO) provides an evidence-based approach toward monitoring and managing the kidney transplant.

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The Change in Allograft Function among Long-Term Kidney Transplant Recipients

Cited by 93 publications

References 30 publications

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Donor Kidney Glomerular Filtration Rate and Post-Transplant Graft Function

Monitoring and Managing Graft Health in the Kidney Transplant Recipient

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