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Repeat renal allografts treated with sirolimus, cyclosporine, anti‐thymocyte globulin induction and continuous steroids achieve similar immunosuppressive efficacy as primary transplants
Author(s) -
Petero Jr Virgilio G.,
Kaposztas Zsolt,
Kahan Barry D.
Publication year - 2010
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2009.01055.x
Subject(s) - medicine , anti thymocyte globulin , sirolimus , urology , tacrolimus , immunosuppression , creatinine , transplantation , regimen , kidney transplantation , panel reactive antibody , renal function , azathioprine , univariate analysis , surgery , gastroenterology , multivariate analysis , disease
Petero VG Jr, Kaposztas Z, Kahan BD. Repeat renal allografts treated with sirolimus, cyclosporine, anti‐thymocyte globulin induction and continuous steroids achieve similar immunosuppressive efficacy as primary transplants.
Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009.01055.x
© 2009 John Wiley & Sons A/S. Abstract: Objective: We sought to examine repeat versus primary renal transplantations using sirolimus‐based regimens. Methods: We compared 98 repeat versus 200 matched primary recipients treated de novo with sirolimus plus cyclosporine. Every repeat case received polyclonal antibody induction and continuous steroids. Outcomes were evaluated over a mean five‐year follow‐up by univariate and multivariate techniques. Kaplan‐Meier plots were analyzed with using log‐rank statistics with significance at P ≤ 0.05. Results: Significant differences in demographic features included greater panel reactive antibody (PRA), younger age, fewer HLA‐mismatches and more pre‐emptive repeat versus primary grafts. Neither graft and patient survivals, nor incidences of biopsy‐proven acute rejection (BPAR), chronic vasculopathy or tubular atrophy/interstitial fibrosis among biopsies performed for cause were significantly different at 1 and 5 years. Younger recipients, better HLA matches and absence of diabetes promoted repeat graft survival; whereas older age, longer cold ischemia time and BPAR reduced primary transplant outcomes. Renal function was similar at 1, 3, 12, 24, 48 and 60 months. Conclusion: At 5 years this sirolimus regimen achieved similar efficacy for repeat versus primary transplantations.