BACKGROUNDThe impact of long-term dialysis (LTD) therapy on the survival benefit of kidneytransplantation compared to short-term dialysis (STD) remains unclear. Additionally,donor organ quality has been identified as ...BACKGROUNDThe impact of long-term dialysis (LTD) therapy on the survival benefit of kidneytransplantation compared to short-term dialysis (STD) remains unclear. Additionally,donor organ quality has been identified as a significant predictor ofpatient survival in deceased donor kidney transplantation.AIMTo investigate the effects of the best graft function within three months posttransplant,as well as dialysis duration, on transplant outcomes.METHODSA total of 255 patients were included in this retrospective cohort study. Patientswere divided into two groups: Those with LTD (≥ 15 years;Group LTD) and thosewith STD (< 15 years;Group STD). Clinical backgrounds and outcomes werecompared between the groups.RESULTSGroup LTD comprised 28 patients, while Group STD included 227 patients. Therewere no significant differences between the two groups in terms of age at transplant,donor age, lowest serum creatinine (best S-Cr) within three months posttransplant,or the frequency of cardiovascular events after transplantation. Multivariateanalysis identified age [hazard ratio (HR): 1.058;95%CI: 1.002-1.116;P =0.040], post-transplant incidence of cardiovascular disease (HR: 20.264;95%CI:6.052-67.850;P < 0.001), and best S-Cr (HR: 4.155;95%CI: 2.234-7.730;P < 0.001) asindependent predictors of mortality after transplantation. The pre-operative dialysisperiod was not statistically significant.CONCLUSIONThese findings suggest that early graft dysfunction, rather than dialysis duration, may serve as a critical risk factorfor poor transplant outcomes.展开更多
This minireview focuses on the current knowledge about the introduction of everolimus(EVL),a mammalian target of rapamycin inhibitor,with calcineurin inhibitor(CNI)elimination or minimization in kidney transplant reci...This minireview focuses on the current knowledge about the introduction of everolimus(EVL),a mammalian target of rapamycin inhibitor,with calcineurin inhibitor(CNI)elimination or minimization in kidney transplant recipients at a late posttransplant stage.Within,we have summarized two major clinical trials,ASCERTAIN and APOLLO,and seven other retrospective or nonrandomized studies.In the open-label multicenter ASCERTAIN study,the estimated glomerular filtration rate(eGFR)at 24 mo after conversion was not significantly different between three groups-EVL with CNI elimination,CNI minimization and continued CNI unchanged-at a mean of 5.4 years after transplantation.However,recipients with baseline creatinine clearance higher than 50 mL/min had a greater increase in measured GFR after CNI elimination.In the open-label multicenter APOLLO study,adjusted e GFR within the on-treatment population was significantly higher in the EVL continuation group than in the CNI continuation group at 12 mo after conversion at a mean of 7 years posttransplantation.Other studies on recipients without adverse events and already having satisfactory renal function showed favorable graft function by EVL late-induction with CNI elimination or reduction.These studies showed that chronic allograft nephropathy,CNI nephrotoxicity,CNI arteriolopathy,cancer and viral infection(especially cytomegalovirus infection)may be good indications for late conversion to EVL.展开更多
文摘BACKGROUNDThe impact of long-term dialysis (LTD) therapy on the survival benefit of kidneytransplantation compared to short-term dialysis (STD) remains unclear. Additionally,donor organ quality has been identified as a significant predictor ofpatient survival in deceased donor kidney transplantation.AIMTo investigate the effects of the best graft function within three months posttransplant,as well as dialysis duration, on transplant outcomes.METHODSA total of 255 patients were included in this retrospective cohort study. Patientswere divided into two groups: Those with LTD (≥ 15 years;Group LTD) and thosewith STD (< 15 years;Group STD). Clinical backgrounds and outcomes werecompared between the groups.RESULTSGroup LTD comprised 28 patients, while Group STD included 227 patients. Therewere no significant differences between the two groups in terms of age at transplant,donor age, lowest serum creatinine (best S-Cr) within three months posttransplant,or the frequency of cardiovascular events after transplantation. Multivariateanalysis identified age [hazard ratio (HR): 1.058;95%CI: 1.002-1.116;P =0.040], post-transplant incidence of cardiovascular disease (HR: 20.264;95%CI:6.052-67.850;P < 0.001), and best S-Cr (HR: 4.155;95%CI: 2.234-7.730;P < 0.001) asindependent predictors of mortality after transplantation. The pre-operative dialysisperiod was not statistically significant.CONCLUSIONThese findings suggest that early graft dysfunction, rather than dialysis duration, may serve as a critical risk factorfor poor transplant outcomes.
文摘This minireview focuses on the current knowledge about the introduction of everolimus(EVL),a mammalian target of rapamycin inhibitor,with calcineurin inhibitor(CNI)elimination or minimization in kidney transplant recipients at a late posttransplant stage.Within,we have summarized two major clinical trials,ASCERTAIN and APOLLO,and seven other retrospective or nonrandomized studies.In the open-label multicenter ASCERTAIN study,the estimated glomerular filtration rate(eGFR)at 24 mo after conversion was not significantly different between three groups-EVL with CNI elimination,CNI minimization and continued CNI unchanged-at a mean of 5.4 years after transplantation.However,recipients with baseline creatinine clearance higher than 50 mL/min had a greater increase in measured GFR after CNI elimination.In the open-label multicenter APOLLO study,adjusted e GFR within the on-treatment population was significantly higher in the EVL continuation group than in the CNI continuation group at 12 mo after conversion at a mean of 7 years posttransplantation.Other studies on recipients without adverse events and already having satisfactory renal function showed favorable graft function by EVL late-induction with CNI elimination or reduction.These studies showed that chronic allograft nephropathy,CNI nephrotoxicity,CNI arteriolopathy,cancer and viral infection(especially cytomegalovirus infection)may be good indications for late conversion to EVL.
