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A novel approach to the treatment of chronic allograft nephropathy.

Publication ,  Journal Article
Weir, MR; Anderson, L; Fink, JC; Gabregiorgish, K; Schweitzer, EJ; Hoehn-Saric, E; Klassen, DK; Cangro, CB; Johnson, LB; Kuo, PC; Lim, JY ...
Published in: Transplantation
December 27, 1997

BACKGROUND: Progressive deterioration of renal function in kidney transplant recipients is the leading cause of graft failure. Both nonimmunologic and immunologic mechanisms contribute to this deterioration. METHODS: Twenty-eight cyclosporine (CsA)-treated renal transplant recipients (21 cadaveric, 5 living, 2 simultaneous kidney-pancreas) with progressive deterioration of renal function were prospectively enrolled in a clinical trial and had their immunosuppressive regimen changed 24.3+/-7.7 months after transplant. All patients had their CsA dose reduced by 50%, azathioprine was discontinued, and mycophenolate mofetil was added to the medical regimen. The mean creatinine of the patients at the initiation of the change in immunosuppression was 3.5+/-1.2 mg/dl (range 1.9 to 6.2 mg/dl). RESULTS: Before the change in immunosuppression, the mean loss in renal function as indicated by the least-squares slope of the reciprocal of creatinine versus time was -0.006+/-0.002 (mg/dl)-1 per month. The change in immunosuppression significantly decreased the rate of loss in renal function for most patients when compared with their pretreatment values with a mean slope of 0.007+/-0.003 (mg/dl)-1 per month (P=0.003). Renal function improved in 21 of 28 patients. Only one patient had continued deterioration of renal function. In a multivariate analysis adjusting for CsA dose, mean arterial blood pressure, and baseline creatinine, the change in immunosuppression was significantly associated with improved renal function (P=0.02). There were no acute rejections after the immunosuppression change. CONCLUSIONS: We conclude that adding mycophenolate mofetil and reducing CsA in patients with chronic deterioration of graft function is well tolerated and results in a short-term improvement in renal function.

Duke Scholars

Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

December 27, 1997

Volume

64

Issue

12

Start / End Page

1706 / 1710

Location

United States

Related Subject Headings

  • Surgery
  • Prospective Studies
  • Prednisone
  • Mycophenolic Acid
  • Middle Aged
  • Male
  • Kidney Transplantation
  • Kidney Diseases
  • Immunosuppressive Agents
  • Immunosuppression Therapy
 

Citation

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Weir, M. R., Anderson, L., Fink, J. C., Gabregiorgish, K., Schweitzer, E. J., Hoehn-Saric, E., … Bartlett, S. T. (1997). A novel approach to the treatment of chronic allograft nephropathy. Transplantation, 64(12), 1706–1710. https://doi.org/10.1097/00007890-199712270-00013
Weir, M. R., L. Anderson, J. C. Fink, K. Gabregiorgish, E. J. Schweitzer, E. Hoehn-Saric, D. K. Klassen, et al. “A novel approach to the treatment of chronic allograft nephropathy.Transplantation 64, no. 12 (December 27, 1997): 1706–10. https://doi.org/10.1097/00007890-199712270-00013.
Weir MR, Anderson L, Fink JC, Gabregiorgish K, Schweitzer EJ, Hoehn-Saric E, et al. A novel approach to the treatment of chronic allograft nephropathy. Transplantation. 1997 Dec 27;64(12):1706–10.
Weir, M. R., et al. “A novel approach to the treatment of chronic allograft nephropathy.Transplantation, vol. 64, no. 12, Dec. 1997, pp. 1706–10. Pubmed, doi:10.1097/00007890-199712270-00013.
Weir MR, Anderson L, Fink JC, Gabregiorgish K, Schweitzer EJ, Hoehn-Saric E, Klassen DK, Cangro CB, Johnson LB, Kuo PC, Lim JY, Bartlett ST. A novel approach to the treatment of chronic allograft nephropathy. Transplantation. 1997 Dec 27;64(12):1706–1710.

Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

December 27, 1997

Volume

64

Issue

12

Start / End Page

1706 / 1710

Location

United States

Related Subject Headings

  • Surgery
  • Prospective Studies
  • Prednisone
  • Mycophenolic Acid
  • Middle Aged
  • Male
  • Kidney Transplantation
  • Kidney Diseases
  • Immunosuppressive Agents
  • Immunosuppression Therapy