Document Detail


Impact of tacrolimus-sirolimus maintenance immunosuppression on proteinuria and kidney function in pancreas transplant alone recipients.
MedLine Citation:
PMID:  23037007     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Nephrotoxicity is a major complication with immunosuppression regimens used in transplantation. Calcineurin inhibitor-sparing or reduction regimens using sirolimus (SRL) have shown variable success in kidney transplantation. There is limited data on the role of SRL on native kidney function in pancreas transplantation.
METHODS: All patients undergoing pancreas transplantation from 2003 to 2010 were enrolled in this study (n=65). Patient demographic characteristics were identified and divided into two groups: those receiving tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and those maintained on a regimen of Tac and SRL with or without MMF. The slopes for estimated glomerular filtration rate (eGFR), serum creatinine level (sCr), and proteinuria changes over time were assessed between groups. Urine protein and creatinine ratio (uPr/uCr) was used to assess proteinuria.
RESULTS: There was no difference in baseline demographic characteristics. Patients were followed for a median of 3 years. Baseline sCr and eGFR were similar between groups. Differences in uPr/uCr and rate of change in sCr and eGFR were not significant between the groups overall or for any specific time. There was worsening of sCr, eGFR, and uPr/uCr within the groups over the period of study. There were no significant differences when groups were split by age or gender or when the SRL group was split further based on MMF inclusion.
CONCLUSIONS: Our study findings suggest that using a Tac-SRL regimen in patients with pancreas alone transplantation is a safe approach and may not lead to worsening proteinuria and kidney function when compared with regimens using Tac with MMF.
Authors:
Praveen Kandula; Jonathan Fridell; Tim E Taber; Asif Sharfuddin; Muhammad S Yaqub; Carrie L Phillips; Jeannie Chen; Muhammad Mujtaba
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation     Volume:  94     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-06     Completed Date:  2013-01-14     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  940-6     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Biopsy
Creatinine / urine
Drug Therapy, Combination
Female
Glomerular Filtration Rate / physiology
Graft Rejection / prevention & control*
Humans
Immunosuppressive Agents / pharmacology,  therapeutic use*
Incidence
Kidney / drug effects,  physiology*
Male
Middle Aged
Mycophenolic Acid / analogs & derivatives,  pharmacology,  therapeutic use
Pancreas Transplantation*
Proteinuria / epidemiology*
Retrospective Studies
Sex Factors
Sirolimus / pharmacology,  therapeutic use*
Tacrolimus / pharmacology,  therapeutic use*
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 109581-93-3/Tacrolimus; 24280-93-1/Mycophenolic Acid; 53123-88-9/Sirolimus; 60-27-5/Creatinine; 9242ECW6R0/mycophenolate mofetil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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