Jordan, ML and Shapiro, R and Vivas, CA and Scantlebury, VP and Rhandhawa, P and Carrieri, G and Mc Cauley, J and Demetris, AJ and Tzakis, A and Fung, JJ and Simmons, RL and Hakala, TR and Starzl, TE
(1994)
Fk506 “rescue” for resistant rejection of renal allografts under primary cyclosporine immunosuppression.
Transplantation, 57 (6).
860 - 865.
ISSN 0041-1337
Abstract
Seventy-seven patients with ongoing acute rejection on initial CsA therapy were converted to FK506 to attempt graft salvage. Fifty-nine patients had undergone primary transplantation and 18 had been retransplanted; there were 52 cadaveric and 25 living-donor transplants. The indications for conversion to FK506 were ongoing, biopsy-confirmed rejection in all patients, including vascular rejection in 20. The median interval to rescue was 2 months (range 2 weeks to 36 months) after transplantation. Sixty-one of the 77 patients (79%) had already received one or more courses of an antilymphocyte preparation (OKT3: n=33; ALG or ATG: n=1; OKT3+ALG/ATG: n=27). Of the 77 patients, 57 (74%) have been successfully rescued and still have functioning grafts with a mean follow-up of 14 months, with a mean serum creatinine of 2.35±0.97 mg/dl. Eighteen patients were already dialysis-dependent at the time of conversion to FK506; of these, 9 (50%) were successfully salvaged and have a mean serum creatinine of 2.3 mg/dl. Of the 61 patients previously treated with antilymphocyte preparations, 48 (79%) were rescued. In those salvaged, prednisone doses have been lowered from 22.2±7.2 mg/day preconversion to 7.5±5.6 mg/day postconversion, and 12 patients are on FK506 monotherapy. In nondiabetics, mean serum glucose was 101.4±20.5 mg/dl preconversion and 93.2±22 postconversion (P=0.07), uric acid 7.3±2.3 and 7.1±1.5 mg/dl (P=0.53), and triglycerides 199.2±101.6 and 167.2±106.4 mg/dl (P=0.06). Cholesterol levels were significantly lower following FK conversion (207.7±46.5 mg/dl pre. vs. 188.3±39.7 post, P=0.007). FK506 is capable of salvaging renal allografts with ongoing acute rejection on CsA therapy, even when antilymphocyte preparations have been ineffective. © 1994 by Williams and Wilkins.
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| Item Type: |
Article
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| Status: |
Published |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Jordan, ML | | | | | Shapiro, R | | | | | Vivas, CA | | | | | Scantlebury, VP | | | | | Rhandhawa, P | | | | | Carrieri, G | | | | | Mc Cauley, J | | | | | Demetris, AJ | | | | | Tzakis, A | | | | | Fung, JJ | | | | | Simmons, RL | | | | | Hakala, TR | | | | | Starzl, TE | tes11@pitt.edu | TES11 | |
|
| Centers: |
Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute |
| Date: |
1 January 1994 |
| Date Type: |
Publication |
| Journal or Publication Title: |
Transplantation |
| Volume: |
57 |
| Number: |
6 |
| Page Range: |
860 - 865 |
| DOI or Unique Handle: |
10.1097/00007890-199403270-00016 |
| Institution: |
University of Pittsburgh |
| Refereed: |
Yes |
| ISSN: |
0041-1337 |
| Other ID: |
uls-drl:31735062125699, Starzl CV No. 1615 |
| Date Deposited: |
08 Apr 2010 17:27 |
| Last Modified: |
19 Jul 2020 11:55 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/5001 |
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