Posts Tagged ‘renal transplant’

July 8, 2012

Leflunomide Efficacy and Pharmacodynamics for the Treatment of BK Viral Infection

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Leflunomide has been proposed as a replacement for mycophenolic acid in patients with BK nephropathy, as it has immunosuppressive properties and activity against BK in vitro. In this retrospective study, there was no correlation between leflunomide metabolite levels and clearance of BK viremia. This study highlights the need for well-designed randomized controlled trials to determine […]

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July 8, 2012

Randomized Phase 2b Trial of Tofacitinib (CP-690,550) in De Novo Kidney Transplant Patients: Efficacy, Renal Function and Safety at 1 Year

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Tofacitinib is the first in a new class of immunosuppressive agents that inhibit janus kinase, an important transcription factor. This randomized-controlled trial compared tofacitinib to cyclosporine in renal transplant patients. Tofacitinib showed lower rates of acute rejection and chronic changes on biopsy, with better renal function compared to a cyclosporine-based regimen. On the other hand, […]

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July 8, 2012

Randomized Trial of Short-Course High-Dose Erythropoietin in Donation After Cardiac Death Kidney Transplant Recipients

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Donation after cardiac death (DCD) donors have become an important source of organs, but the rates of delayed graft function (DGF) remains high. Erythropoietin may protect against schema-reperfusion injury. In this randomized controlled trial, erythropoietin or placebo was given to recipients of DCD kidneys. There was no difference in DGF rates, acute rejection, or renal […]

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July 8, 2012

Tolerance and Withdrawal of Immunosuppressive Drugs in Patients Given Kidney and Hematopoietic Cell Transplants

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While tolerance is one of the ultimate goals for transplantation, there have been few studies rigorously attempting tolerogenic protocols. This paper reports the results of an attempt to induce tolerance using a combination of total lymphoid radiation, thymoglobulin and donor bone-marrow cell infusion in recipients of very closely HLA-matched kidneys. Immunosuppression was completely withdrawn in […]

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May 23, 2012

Pretransplant Donor-Specific HLA Class-I and -II Antibodies Are Associated with an Increased Risk for Kidney Graft Failure

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The recent development of Luminex reagents capable of detecting complement fixing HLA antibodies has sparked a lot of interest in the best way to apply this information. This study examined C1Q-fixing HLA antibodies in a retrospective study of pre-transplant samples in patients transplanted across a negative cytotoxic cross-match. Of the 837 sera examined, 210 contained […]

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May 23, 2012

Frequency of HLA-DP-specific antibodies and a possible new cross-reacting group

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Donor specific HLA antibodies to mismatched class II antigens are a common feature of late kidney graft loss. Although antibodies to HLA-DR and -DQ antigens have been recognized for quite some time, antibodies to HLA-DP have an unclear clinical significance. This study examined the incidence of HLA-DP-specific antibodies in 650 patients on the kidney transplant […]

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April 5, 2012

Understanding the Causes of Kidney Transplant Failure: The Dominant Role of Antibody-Mediated Rejection and Nonadherence

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Understanding the causes of renal allograft failure is key in improving long-term graft survival. In this study, for-cause biopsies were analyzed, and outcomes were related to the biopsy finding. Notably, acute T-cell mediated cellular rejection rarely led to graft loss. In contrast, all patients who experienced graft loss demonstrated some degree of antibody-mediated rejection on […]

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April 5, 2012

A Randomized Trial With Steroids and Antithymocyte Globulins Comparing Cyclosporine/Azathioprine Versus Tacrolimus/Mycophenolate Mofetil (CATM2) in Renal Transplantation

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In the last few years, the tacrolimus and mycophenolic acid has become the most popular therapy used in renal transplant, rather than the older cyclosporine and azathioprine combination. These authors conducted a randomized controlled trial to see whether the use of lymphocyte-depleting induction therapy would give equivalent results between these two drug regimens. In fact, […]

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April 5, 2012

Very early steroid withdrawal or complete avoidance for kidney transplant recipients: a systematic review

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There have been a number of randomized controlled trials over the last few years comparing early corticosteroid withdrawal post-renal transplant to long-term low-dose steroids. This meta-analysis found nine randomized controlled trials using modern immunosuppression protocols to assess the impact of early steroid withdrawal. Patients received tacrolimus or cyclosporine; mycophenolic acid or an mTOR inhibitor; and […]

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