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Nephrotoxizitätsfreie Immunsuppression bei älteren Empfängern von postmortal entnommenen Nieren älterer Organspender - Ergebnisse einer prospektiven Pilotstudie -
Nephrotoxizitätsfreie Immunsuppression bei älteren Empfängern von postmortal entnommenen Nieren älterer Organspender - Ergebnisse einer prospektiven Pilotstudie -
Background. With the aim to improve the inferior outcomes in elderly recipients of kidneys from elderly cadaver donors, we applied and investigated a therapeutic regimen consisting of Calcineurin- inhibitor-free, mycophenolate mofetil (MMF) – based immunosuppressive induction/maintenance protocol. In this article, we report the long-term results of this clinical trial. Methods. 89 recipients (mean age:63,8 y) of kidneys from cadaver donors (mean age: 66,8y) were consecutively recruited for this 5-year, prospective, open, single centre, pilot trial. Induction therapy consisted of MMF and steroids in conjunction with a a short course (4-10 days) of rabbit ATG. Maintenance treatment was performed with MMF/steroids or MMF alone under strict therapeutic drug monitoring by aiming target MPA-trough levels between 2 – 6 mg/mL. Results. Cumulative 5-year patient and renal allograft survival was 87,69 % and 69,81 %, respectively. Acute rejection episodes occurred in 23,6 % (21 patients). Long-term function of the old renal allografts proved to be satisfactory as reflected by serum Creatinine-values of 1,53 mg/dl and Urea-values of 57,9 mg/dl at 5 years. Conclusion. Application of a nephrotoxicity- and atherogenicity-free, MMF-based immunosuppressive induction/maintenance protocol in elderly recipient of kidneys from elderly cadaver donors leads to improved long-term outcomes which are comparable with data from young recipients who have received allografts from young cadaver donors.
kidney transplantation, old donors, old recipients, innate immunity, mycophenolate mofetil
Hückelheim, Henning
2006
Deutsch
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Hückelheim, Henning (2006): Nephrotoxizitätsfreie Immunsuppression bei älteren Empfängern von postmortal entnommenen Nieren älterer Organspender - Ergebnisse einer prospektiven Pilotstudie -. Dissertation, LMU München: Medizinische Fakultät
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Abstract

Background. With the aim to improve the inferior outcomes in elderly recipients of kidneys from elderly cadaver donors, we applied and investigated a therapeutic regimen consisting of Calcineurin- inhibitor-free, mycophenolate mofetil (MMF) – based immunosuppressive induction/maintenance protocol. In this article, we report the long-term results of this clinical trial. Methods. 89 recipients (mean age:63,8 y) of kidneys from cadaver donors (mean age: 66,8y) were consecutively recruited for this 5-year, prospective, open, single centre, pilot trial. Induction therapy consisted of MMF and steroids in conjunction with a a short course (4-10 days) of rabbit ATG. Maintenance treatment was performed with MMF/steroids or MMF alone under strict therapeutic drug monitoring by aiming target MPA-trough levels between 2 – 6 mg/mL. Results. Cumulative 5-year patient and renal allograft survival was 87,69 % and 69,81 %, respectively. Acute rejection episodes occurred in 23,6 % (21 patients). Long-term function of the old renal allografts proved to be satisfactory as reflected by serum Creatinine-values of 1,53 mg/dl and Urea-values of 57,9 mg/dl at 5 years. Conclusion. Application of a nephrotoxicity- and atherogenicity-free, MMF-based immunosuppressive induction/maintenance protocol in elderly recipient of kidneys from elderly cadaver donors leads to improved long-term outcomes which are comparable with data from young recipients who have received allografts from young cadaver donors.