Transplantation research最新文献_第4页

Reviewer acknowledgement 2013 审稿人致谢

Transplantation research Pub Date : 2014-02-05 DOI: 10.1186/2047-1440-3-3

E. Geissler, A. Jardine

引用次数: 0

Long-term mycophenolate monotherapy in human leukocyte antigen (HLA)-identical living-donor kidney transplantation. 人类白细胞抗原（HLA）相同的活体供肾移植中的长期霉酚酸酯单药治疗。

Transplantation research Pub Date : 2014-02-03 DOI: 10.1186/2047-1440-3-4

Blanca Gascó, Ignacio Revuelta, Ana Sánchez-Escuredo, Miquel Blasco, Federico Cofán, Nuria Esforzado, Luis F Quintana, María José Ricart, José Vicente Torregrosa, Josep M Campistol, Federico Oppenheimer, Fritz Diekmann

{"title":"Long-term mycophenolate monotherapy in human leukocyte antigen (HLA)-identical living-donor kidney transplantation.","authors":"Blanca Gascó, Ignacio Revuelta, Ana Sánchez-Escuredo, Miquel Blasco, Federico Cofán, Nuria Esforzado, Luis F Quintana, María José Ricart, José Vicente Torregrosa, Josep M Campistol, Federico Oppenheimer, Fritz Diekmann","doi":"10.1186/2047-1440-3-4","DOIUrl":"10.1186/2047-1440-3-4","url":null,"abstract":"Unlabelled: Although recipients of a first HLA-identical living-donor kidney transplant seem to need less immunosuppression, there are no guideline recommendations for these patients, and few prospective trials are available.Methods: We analyzed all PRA-negative patients who received a first kidney transplant from an HLA-identical living donor. The patients received no antibody induction. An intraoperative bolus of 500 mg of methylprednisolone was administered. Then, steroid therapy was withdrawn within one week. Tacrolimus and mycophenolate treatment were started 3 days before transplantation with tacrolimus target levels of 4 to 8 ng/mL. In the absence of rejection, tacrolimus was withdrawn between 3 and 12 months post-transplant to reach mycophenolate mofetil monotherapy of 2 g/day or equivalent.Results: Six patients were treated with the above protocol. At last follow-up, graft and patient survival were 100%. MDRD glomerular filtration rates were 54, 60, and 62 mL/min at 3 months, 12 months and last follow-up, respectively. None of the patients developed PRA post-transplant. One episode of acute rejection Banff IA occurred 9 years after transplantation due to non-adherence with good outcome after treatment. The mean number of concomitant drugs given with mycophenolate was 2.6. Four patients needed antihypertensive drugs.Conclusion: Steroid-free de novo treatment and calcineurin-inhibitor weaning with mycophenolate monotherapy is feasible in first HLA-identical kidney transplantation from a living sibling.","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"3 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2014-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32084847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Eligibility for the kidney transplant wait list: a model for conceptualizing patient risk. 肾移植等待名单的资格:一个概念化患者风险的模型。

Transplantation research Pub Date : 2014-01-08 DOI: 10.1186/2047-1440-3-2

Bryce A Kiberd, Karthik K Tennankore, Kenneth West

{"title":"Eligibility for the kidney transplant wait list: a model for conceptualizing patient risk.","authors":"Bryce A Kiberd, Karthik K Tennankore, Kenneth West","doi":"10.1186/2047-1440-3-2","DOIUrl":"https://doi.org/10.1186/2047-1440-3-2","url":null,"abstract":"Background: Determining eligibility for a kidney transplant is one of the most important decisions facing nephrologists. It is assumed that the harm of kidney transplantation is minimal and most will benefit. The purpose of this study was to quantify the probability of 'no benefit' as defined by death on the wait list; 'harm', defined by the probability that a transplanted patient would live less than the average wait listed patient; and 'benefit' for the probability a transplanted patient would outlive the average wait listed patient.Methods: A computerized model was developed to replicate observed patient survival outcomes in deceased donor kidney transplantation. Three sequential periods of risk for the transplanted recipient compared to the wait listed cohort (increased, equivalent and reduced risk) were modeled.Results: The model predicted that wait listed patients with a baseline mortality of 28 deaths per 100 patient years were equally likely to benefit or be harmed with a transplant. However if 20% of patients on the wait list were on hold (assuming a 2.2-fold higher mortality than those who were transplanted), then the baseline mortality rate for equal harm or benefit decreases to 22 deaths per 100 patient years (equivalent life expectancy 4.5 years).Conclusion: Patients with limited life expectancies are more likely to suffer some harm than derive benefit from kidney transplantation.","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"3 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2014-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-3-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32011195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

Timing of rabbit antithymocyte globulin induction therapy in kidney transplantation: an observational cohort study. 兔抗胸腺细胞球蛋白诱导治疗肾移植的时机:一项观察性队列研究。

Transplantation research Pub Date : 2014-01-03 DOI: 10.1186/2047-1440-3-1

Jennifer J Harrison, Bassem Hamandi, Yanhong Li, Olusegun Famure, S Joseph Kim

{"title":"Timing of rabbit antithymocyte globulin induction therapy in kidney transplantation: an observational cohort study.","authors":"Jennifer J Harrison, Bassem Hamandi, Yanhong Li, Olusegun Famure, S Joseph Kim","doi":"10.1186/2047-1440-3-1","DOIUrl":"https://doi.org/10.1186/2047-1440-3-1","url":null,"abstract":"Background: Literature on the timing of rabbit antithymocyte globulin (rATG) induction and its effects on kidney transplant outcomes is limited. The manufacturer recommends that the first dose be given intra-operatively, however this may present clinical practice risks and challenges. Our objective was to assess the impact of the timing of the first dose of rATG on kidney transplant outcomes.Methods: Incident kidney transplant recipients (KTR) from January 2002 to December 2009 receiving the first dose of rATG post-operatively (Post, n = 353) or before reperfusion (Pre, n = 124) were evaluated. Outcomes assessed included eGFR at 1-year, delta eGFR (12 versus 1 month), and incidence of biopsy-proven acute rejection, graft loss, death, and a composite of the time-to-event outcomes. The impact of timing on outcomes was adjusted for potential confounders and assessed using linear and Cox regression models.Results: Among 435 KTR surviving with function to 12 months post-transplant, there was no significant difference in mean estimated glomerular filtration rate or eGFR (55.0 versus 56.7 mL/min, P = 0.46) and delta eGFR (1.8 versus 0.3 mL/min, P = 0.40) in Post versus Pre groups, respectively. At a median follow-up of 3 years, the composite endpoint (time to first biopsy-proven acute rejection, graft loss, or death) was similar by timing group (adjusted HR = 0.94; 95% CI: 0.58, 1.53, P = 0.81) in the total study population.Conclusions: Timing of rATG had no appreciable impact on clinically relevant endpoints in this study cohort. These results support consideration of more flexible timing of the first dose of rATG induction in KTR.","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"3 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2014-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-3-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31999060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

Challenges in machine perfusion preservation for liver grafts from donation after circulatory death. 循环性死亡后捐献肝的机器灌注保存面临的挑战。

Transplantation research Pub Date : 2013-11-27 DOI: 10.1186/2047-1440-2-19

Naoto Matsuno, Eiji Kobayashi

引用次数: 11

Optimising the use of mTOR inhibitors in renal transplantation. 优化mTOR抑制剂在肾移植中的应用。

Transplantation research Pub Date : 2013-11-20 DOI: 10.1186/2047-1440-2-S1-S4

Graeme R Russ

{"title":"Optimising the use of mTOR inhibitors in renal transplantation.","authors":"Graeme R Russ","doi":"10.1186/2047-1440-2-S1-S4","DOIUrl":"https://doi.org/10.1186/2047-1440-2-S1-S4","url":null,"abstract":"Renal transplantation is the treatment of choice for end-stage renal failure. Although advances in immunosuppression have led to improvements in short-term outcomes, graft survival beyond 5 to 10 years has not improved. One of the major causes of late renal allograft failure is chronic allograft nephropathy, a component of which is nephrotoxicity from the use of calcineurin inhibitors (CNIs). In addition, premature patient death is a major limitation of renal transplantation and the major causes are cancer, cardiovascular disease and infection. CNI-free immunosuppressive regimens based on mammalian target of rapamycin (mTOR) inhibitors have been trial led over the last few years and have defined the rational use of these agents. Conversion from a CNI-based to an mTOR-inhibitor-based regimen has been successful at improving renal function for a number of years after conversion, although long-term survival outcomes are still awaited. The studies suggest that the safest and most effective time to convert is between 1 and 6 months after transplant. In addition, mTOR-inhibitor-based regimens have been shown to be associated with lower rates of post-transplant malignancy and less cytomegalovirus infection, which may add further to the appeal of this approach. ","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 Suppl 1","pages":"S4"},"PeriodicalIF":0.0,"publicationDate":"2013-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-S1-S4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32149816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 14

JAK3 inhibition: what potential for the future? JAK3抑制:未来的潜力是什么?

Transplantation research Pub Date : 2013-11-20 DOI: 10.1186/2047-1440-2-S1-S6

Christophe Legendre

引用次数: 3

What are the key challenges we face in kidney transplantation today? 今天我们在肾移植方面面临的主要挑战是什么?

Transplantation research Pub Date : 2013-11-20 DOI: 10.1186/2047-1440-2-S1-S1

Jeremy R Chapman

{"title":"What are the key challenges we face in kidney transplantation today?","authors":"Jeremy R Chapman","doi":"10.1186/2047-1440-2-S1-S1","DOIUrl":"https://doi.org/10.1186/2047-1440-2-S1-S1","url":null,"abstract":"Transplantation is more predictable than it was 20 to 30 years ago and innovation over the last 20 years has been rapid, delivering substantial short-term and medium-term improvements. The challenges ahead are to deliver improved results globally in the context of also preventing chronic disease and reducing the costs of treatment. Countries achieving the best rates of transplantation combine deceased and living donors and can transplant more than 50 people per annum per million population, so why can this not be achieved everywhere? The mortality rates have dropped, but they are still up to 10-fold worse than age- and sex-matched controls, such that transplantation ages individuals by 30 years in terms of mortality risk. Cardiovascular disease, infection and malignancy remain the targets if mortality is to normalize. Graft survival rates will not change until the multiple injuries constituting chronic allograft dysfunction and the problems of recurrent disease can be brought to heel. Biomarkers may provide the next innovation to advance outcomes, but early experimental tolerance protocols implemented in clinical practice in at least three centers may deliver results more quickly. ","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 Suppl 1","pages":"S1"},"PeriodicalIF":0.0,"publicationDate":"2013-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-S1-S1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32149394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 44

Conversion to mTOR-inhibitor-based immunosuppression: which patients and when? 转向基于mtor抑制剂的免疫抑制:哪些患者和何时?

Transplantation research Pub Date : 2013-11-20 DOI: 10.1186/2047-1440-2-S1-S3

Philippe Gatault, Yvon Lebranchu

{"title":"Conversion to mTOR-inhibitor-based immunosuppression: which patients and when?","authors":"Philippe Gatault, Yvon Lebranchu","doi":"10.1186/2047-1440-2-S1-S3","DOIUrl":"https://doi.org/10.1186/2047-1440-2-S1-S3","url":null,"abstract":"Mammalian target of rapamycin (mTOR) inhibitors are currently considered an alternative immunosuppressive treatment that can prevent the nephrotoxicity, viral infections and malignancies that are associated with calcineurin inhibitor-based immunosuppressive regimens. However, the side effects of mTOR-inhibitor-based regimens lead to frequent treatment discontinuations, and not all patients seem to have the same benefits from conversion to mTOR inhibitors. This review focuses on long-term results of trials that have assessed early and late conversion to sirolimus or everolimus. The renal benefit of late conversion (≥1 year post transplantation) is limited, except in patients with good renal function and without proteinuria. Early conversion to mTOR inhibitors in the first 6 months, in combination with mycophenolate mofetil, could be an appropriate strategy for maintenance therapy in renal transplant recipients with a low immunological risk after careful screening at the time of conversion. Good renal function (glomerular filtration rate >40 ml/ minute), weak proteinuria (<1 g/day), an absence of previous acute rejection and subclinical rejection, and appearance of donor-specific anti-human leukocyte antigen antibodies appear to be the most important criteria in identifying patients for whom conversion to an mTOR inhibitor may improve renal function at 5 years. ","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 Suppl 1","pages":"S3"},"PeriodicalIF":0.0,"publicationDate":"2013-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-S1-S3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32149541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 20

The influence of mTOR inhibitors on immunity and the relationship to post-transplant malignancy. mTOR抑制剂对免疫的影响及其与移植后恶性肿瘤的关系。

Transplantation research Pub Date : 2013-11-20 DOI: 10.1186/2047-1440-2-S1-S2

Edward K Geissler

{"title":"The influence of mTOR inhibitors on immunity and the relationship to post-transplant malignancy.","authors":"Edward K Geissler","doi":"10.1186/2047-1440-2-S1-S2","DOIUrl":"https://doi.org/10.1186/2047-1440-2-S1-S2","url":null,"abstract":"The known role of mammalian target of rapamycin (mTOR) in the immune response has been rapidly evolving, from what was once thought to be a simple immunosuppressive antiproliferative effect on T cells to a very complex central role that serves to integrate multiple signals given to T cells, B cells and antigen-presenting cells. The complexity of this topic is demonstrated by recent data suggesting that mTOR inhibition can either inhibit or promote certain aspects of immune responses, depending on the nature of the antigenic stimulus, and the environmental conditions cueing the cellular immunological players. There is even evidence that, under mTOR inhibition, an immune response to one foreign entity (for example, an organ transplant) may be simultaneously completely different to that of another (for example, tumour or microorganism). To understand how this might be possible, it is necessary to investigate the central role that mTOR seems to have in shaping the immune response. This review is aimed at examining how mTOR controls the development and function of key immune cells, and puts this information primarily in the context of organ transplant rejection and post-transplant malignancy. ","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 Suppl 1","pages":"S2"},"PeriodicalIF":0.0,"publicationDate":"2013-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-S1-S2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32149811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 23