Donor-Specific Anti-Human Leukocyte Antigens Antibodies, Acute Rejection, Renal Function, and Histology in Kidney Transplant Recipients Receiving Tacrolimus and Everolimus
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Data
2017
Autores
Ferreira, Alexandra Nicolau [UNIFESP]
Felipe, Claudia Rosso [UNIFESP]
Cristelli, Marina Pontello [UNIFESP]
Viana, Laila [UNIFESP]
Basso, Geovana [UNIFESP]
Stopa, Suelen[UNIFESP]
Mansur, Juliana Busato [UNIFESP]
Paula, Mayara Ivani de [UNIFESP]
Bessa, Adrieli Barros [UNIFESP]
Ruiz, Priscila Ruppel [UNIFESP]
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Background: This analysis compared efficacy, renal function, and histology in kidney transplant recipients receiving tacrolimus (TAC) combined with everolimus (EVR) or mycophenolate (MPS). Methods: This was a retrospective analysis from a randomized trial in kidney transplant recipients who received a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG), TAC, EVR, and prednisone (PRED
r-ATG/EVR, n = 85), basiliximab (BAS), TAC, EVR, and PRED (BAS/EVR, n = 102) or BAS, TAC, MPS, and PRED (BAS/MPS, n = 101). We evaluated the incidence of de novo donor-specific anti-human leukocyte antigens antibodies (DSA) and histology on protocol biopsies at 12 months, and the incidence of acute rejection, estimated glomerular filtration rate (eGFR) and proteinuria at 36 months. Results: At 12 months, there were no differences in de novo DSA (6.4 vs. 3.4 vs. 5.5%) or in subclinical inflammation (2.0 vs. 4.8 vs. 10.2%), interstitial fibrosis/tubular atrophy (57.1 vs. 58.5 vs. 53.8%) and C4d deposition (2.0 vs. 7.3 vs. 2.6%). At 36 months, there were no differences in the incidence of treatment failure (19.0 vs. 27.7 vs. 27.7%, p = 0.186), first biopsy-proven acute rejection (9.5 vs. 21.8 vs. 16.8%, p = 0.073), and urine protein/creatinine ratios (0.53 +/- 1.05 vs. 0.62 +/- 0.75 vs. 0.71 +/- 1.24). eGFR was lower in the BAS/EVR compared to that in the BAS/MPS group (53.4 +/- 20.9 vs. 50.8 +/- 19.5 vs. 60.7 +/- 21.2 mL/min/1.73 m(2), p = 0.017) but comparable using a sensitive analysis (49.5 +/- 23 vs. 47.5 +/- 22.6 vs. 53.6 +/- 27.8 mL/min/1.73 m(2), p = 0.207). Conclusion: In this cohort, the use of EVR and reduced TAC concentrations were associated with comparable efficacy, renal function, and histological parameters compared to the standard-of-care immunosuppressive regimen. (C) 2017 S. Karger AG, Basel
r-ATG/EVR, n = 85), basiliximab (BAS), TAC, EVR, and PRED (BAS/EVR, n = 102) or BAS, TAC, MPS, and PRED (BAS/MPS, n = 101). We evaluated the incidence of de novo donor-specific anti-human leukocyte antigens antibodies (DSA) and histology on protocol biopsies at 12 months, and the incidence of acute rejection, estimated glomerular filtration rate (eGFR) and proteinuria at 36 months. Results: At 12 months, there were no differences in de novo DSA (6.4 vs. 3.4 vs. 5.5%) or in subclinical inflammation (2.0 vs. 4.8 vs. 10.2%), interstitial fibrosis/tubular atrophy (57.1 vs. 58.5 vs. 53.8%) and C4d deposition (2.0 vs. 7.3 vs. 2.6%). At 36 months, there were no differences in the incidence of treatment failure (19.0 vs. 27.7 vs. 27.7%, p = 0.186), first biopsy-proven acute rejection (9.5 vs. 21.8 vs. 16.8%, p = 0.073), and urine protein/creatinine ratios (0.53 +/- 1.05 vs. 0.62 +/- 0.75 vs. 0.71 +/- 1.24). eGFR was lower in the BAS/EVR compared to that in the BAS/MPS group (53.4 +/- 20.9 vs. 50.8 +/- 19.5 vs. 60.7 +/- 21.2 mL/min/1.73 m(2), p = 0.017) but comparable using a sensitive analysis (49.5 +/- 23 vs. 47.5 +/- 22.6 vs. 53.6 +/- 27.8 mL/min/1.73 m(2), p = 0.207). Conclusion: In this cohort, the use of EVR and reduced TAC concentrations were associated with comparable efficacy, renal function, and histological parameters compared to the standard-of-care immunosuppressive regimen. (C) 2017 S. Karger AG, Basel
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American Journal Of Nephrology. Basel, v. 45, n. 6, p. 497-508, 2017.