首页 | 本学科首页   官方微博 | 高级检索  
     


Minimization of maintenance immunosuppressive therapy after renal transplantation comparing cyclosporine A/azathioprine or cyclosporine A/mycophenolate mofetil bitherapy to cyclosporine A monotherapy: a 10‐year postrandomization follow‐up study
Authors:Antoine Thierry  Yann Lemeur  Laure Ecotière  Ramzi Abou‐Ayache  Isabelle Etienne  Charlotte Laurent  Vincent Vuiblet  Charlotte Colosio  Nicolas Bouvier  Jean‐Claude Aldigier  Jean‐Philippe Rerolle  Vincent Javaugue  Elise Gand  Frank Bridoux  Marie Essig  Bruno Hurault de Ligny  Guy Touchard
Affiliation:1. Service de Néphrologie‐Hémodialyse‐Transplantation rénale, CHU de Poitiers, Poitiers, France;2. Institut National de la Santé et de la Recherche Médicale U1082, Poitiers, France;3. Service de Néphrologie, CHRU, Brest, France;4. Service de Néphrologie, CHRU, Rouen, France;5. Service de Néphrologie, CHRU, Reims, France;6. Service de Néphrologie, CHRU, Caen, France;7. Service de Néphrologie, CHRU, Limoges, France
Abstract:Long‐term outcomes in renal transplant recipients withdrawn from steroid and submitted to further minimization of immunosuppressive regimen after 1 year are lacking. In this multicenter study, 204 low immunological risk kidney transplant recipients were randomized 14.2 ± 3.7 months post‐transplantation to receive either cyclosporine A (CsA) + azathioprine (AZA; n = 53), CsA + mycophenolate mofetil (MMF; n = 53), or CsA monotherapy (n = 98). At 3 years postrandomization, the occurrence of biopsy for graft dysfunction was similar in bitherapy and monotherapy groups (21/106 vs. 26/98; P = 0.25). At 10 years postrandomization, patients’ survival was 100%, 94.2%, and 95.8% (P = 0.25), and death‐censored graft survival was 94.9%, 94.7%, and 95.2% (P = 0.34) in AZA, MMF, and CsA groups, respectively. Mean estimated glomerular filtration rate was 70.4 ± 31.1, 60.1 ± 22.2, and 60.1 ± 19.0 ml/min/1.73 m2, respectively (P = 0.16). The incidence of biopsy‐proven acute rejection was 1.4%/year in the whole cohort. None of the patients developed polyomavirus‐associated nephropathy. The main cause of graft loss (n = 12) was chronic antibody‐mediated rejection (n = 6). De novo donor‐specific antibodies were detected in 13% of AZA‐, 21% of MMF‐, and 14% of CsA‐treated patients (P = 0.29). CsA monotherapy after 1 year is safe and associated with prolonged graft survival in well‐selected renal transplant recipient ( ClinicalTrials.gov number: 980654).
Keywords:cyclosporine A  kidney transplantation  minimization  steroid‐free maintenance immunosuppression
设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号