Identifier to cite or link to this item: http://hdl.handle.net/20.500.13003/15229
Late evolution of kidney transplants in elderly donors and recipients receiving initial immunosuppressant treatment with daclizumab, mycophenolate mofetil, and delayed introduction of tacrolimus
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ISSN: 0211-6995
WOS ID: 000306638600005
Scopus EID: 2-s2.0-84868620662
PMID: 22806279
Embase PUI: L366007868
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Gonzalez-Roncero, Francisco M.; Gentil-Govantes, Miguel A.; Gonzalez-Molina, Miguel; Rivero, Manuel; Cantarell, Carmen; Alarcon, Antonio; Franco, Antonio; Sanchez-Plumed, Jaime; Lampreabe, Ildefonso; Lauzurica, Ricardo; Gonzalez, Esther; Romero, Rafael; Ruiz-San Millan, Juan C.; Osuna, Antonio; Grp Estudio Espanol TrasplantePublication date
2012Document type
research articleCitation
Gonzalez-Roncero FM, Gentil-Govantes MA, Gonzalez-Molina M, Rivero M, Cantarell C, Alarcon A, et al. Late evolution of kidney transplants in elderly donors and recipients receiving initial immunosuppressant treatment with daclizumab, mycophenolate mofetil, and delayed introduction of tacrolimus. Nefrologia. 2012;32(4):446-54.Abstract
Background: Organ transplants in elderly recipients have increased over the past few years. This situation poses specific problems both in terms of organs and recipients; therefore, immunosuppressant regimens must be adapted accordingly. A previous study demonstrated good initial results in kidney transplant cases in which older donors and recipients (average ages of 64.4 years and 61.3 years) had received initial immunosuppressant therapy with daclizumab and mycophenolate mofetil as well as delayed introduction of reduced-dose tacrolimus. In this study we reviewed the long-term results in the same group of patients. Methods: An observational, retrospective multicentre study carried out at a national level to determine survival rates and renal function in 126 patients included in the initial study (127 patients who survived the first year with a functioning graft, 123 treated according to protocol). We gathered data from the 2nd to the 6th year for 120, 118, 113, 102 and 62 patients, respectively. The evolution of renal function, relevant clinical data, and safety profiles were also analysed. Results: After five years, most patients continued with the initial immunosuppressant regimen: 92% tacrolimus and 80% mycophenolate mofetil; 48% had abandoned steroids and proliferation signal inhibitors had been introduced in 3%. Patient and graft survival (adjusted for patient death) after five years was 93.1% and 93.8%, respectively. The main cause of death was neoplasia (in 7 out of 10 cases) whilst graft loss was mainly due to death with a functioning graft. The other causes of death were 2 acute myocardial infarctions and a gastrointestinal haemorrhage. Renal function was moderately but significantly reduced with the passing of time (P<.001): average creatinine levels in the overall group of patients rose from 1.60+/-0.50mg/dl after the 1st year to 1.63+/-0.70mg/dl at the end of study. MDRD dropped from 46.28+/-15.64ml/min after the 1st year to 45.69+/-15.44ml/min at the end of study (P<.01). Only two acute rejections were observed after the 1st year. There were 19 cardiovascular events registered in 12 patients. Conclusions: The regimen used in our study was useful and appropriate for elderly donor-recipient pairs as demonstrated by the good long-term survival results, continued optimum renal function, and acceptable safety profile.
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https://dx.doi.org/10.3265/Nefrologia.pre2012.Mar.11024Keywords
Renal trasplantationDaclizumab
Tacrolimus
Mycophenolate mofetil
Older donor
Elderly recipients
MeSH
Kidney TransplantationDonor Selection
Aged
Age Factors
Kaplan-Meier Estimate
Creatinine
Drug Administration Schedule
Humans
Antibodies, Monoclonal, Humanized
Drug Therapy, Combination
Cause of Death
Middle Aged
Kidney Diseases
Immunosuppressive Agents
Male
Tissue Donors
Immunoglobulin G
Tacrolimus
Graft Survival
Female
Mycophenolic Acid
Treatment Outcome
Survival Rate
Retrospective Studies
DeCS
Resultado del TratamientoÁcido Micofenólico
Tasa de Supervivencia
Tacrolimus
Donantes de Tejidos
Femenino
Supervivencia de Injerto
Inmunosupresores
Enfermedades Renales
Anticuerpos Monoclonales Humanizados
Selección de Donante
Inmunoglobulina G
Masculino
Esquema de Medicación
Quimioterapia Combinada
Humanos
Persona de Mediana Edad
Factores de Edad
Causas de Muerte
Estimación de Kaplan-Meier
Anciano
Creatinina
Trasplante de Riñón
Estudios Retrospectivos