Pediatric renal transplantation with mycophenolate mofetil-based immunosuppression without induction: Results after three years
Mycophenolate mofetil (MMF)-based immunosuppression has reduced the acute rejection rate in adults and in children in the early posttransplantation period. Three-year posttransplantation results have been reported for adults but not for children thus far. In the present open-labeled study, patients...
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| Veröffentlicht in: | Transplantation 2003-02, Vol.75 (4), p.454-461 |
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| creator | JUNGRAITHMAYR, Therese STASKEWITZ, Astrid KLAUS, Günter LEICHTER, Heinz E MIHATSCH, Michael J MICHALK, Dietrich V MISSELWITZ, Joachim PLANK, Christian QUERFELD, Uwe WEBER, Lutz T WIESEL, Manfred TÖNSHOFF, Burkhard KIRSTE, Günter ZIMMERHACKL, Lothar B BÖSWALD, Michael BULLA, Monika BURGHARD, Rainer DIPPELL, Jürgen GREINER, Christel HELMCHEN, Udo KLARE, Bernd |
| description | Mycophenolate mofetil (MMF)-based immunosuppression has reduced the acute rejection rate in adults and in children in the early posttransplantation period. Three-year posttransplantation results have been reported for adults but not for children thus far. In the present open-labeled study, patients 18 years old and younger were evaluated prospectively for up to 3 years after renal transplantation (RTX).
Eighty-six patients receiving MMF in combination with cyclosporine and prednisone without induction were evaluated for patient survival, transplant survival, renal function, arterial blood pressure, adverse events, and opportunistic infections. These patients were compared with a historic control group (n=54) receiving azathioprine (AZA) instead of MMF.
Patient survival after 3 years was 98.8% in the MMF group and 94.4% in the AZA group (NS). Intent-to-treat analysis of graft survival demonstrated superiority for MMF (98% vs. 80%; P |
| doi_str_mv | 10.1097/01.TP.0000045748.95874.64 |
| format | Article |
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Eighty-six patients receiving MMF in combination with cyclosporine and prednisone without induction were evaluated for patient survival, transplant survival, renal function, arterial blood pressure, adverse events, and opportunistic infections. These patients were compared with a historic control group (n=54) receiving azathioprine (AZA) instead of MMF.
Patient survival after 3 years was 98.8% in the MMF group and 94.4% in the AZA group (NS). Intent-to-treat analysis of graft survival demonstrated superiority for MMF (98% vs. 80%; P<0.001). Cumulative acute rejection episodes occurred in 47% of patients in the MMF group versus 61% in the AZA group (P<0.05). Renal function was not significantly different, neither after 3 years nor in the long-term calculation. Antihypertensive medication was administered to 73% to 84% of patients, similar in both groups. Opportunistic infections were recorded only for MMF. Infection rates were comparable to those reported in adults.
These results suggest that MMF is safe and beneficial as a longer term maintenance immunosuppressive drug in children and adolescents.</description><identifier>ISSN: 0041-1337</identifier><identifier>EISSN: 1534-6080</identifier><identifier>DOI: 10.1097/01.TP.0000045748.95874.64</identifier><identifier>PMID: 12605109</identifier><identifier>CODEN: TRPLAU</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Acute Disease ; Adolescent ; Azathioprine - administration & dosage ; Biological and medical sciences ; Blood Pressure ; Child ; Cyclosporine - administration & dosage ; Female ; Follow-Up Studies ; Graft Rejection - drug therapy ; Graft Rejection - mortality ; Graft Survival - drug effects ; Humans ; Hypertension - diagnosis ; Hypertension - therapy ; Immunomodulators ; Immunosuppressive Agents - administration & dosage ; Immunosuppressive Agents - adverse effects ; Kidney - physiology ; Kidney Transplantation ; Male ; Medical sciences ; Mycophenolic Acid - administration & dosage ; Mycophenolic Acid - adverse effects ; Mycophenolic Acid - analogs & derivatives ; Pharmacology. Drug treatments ; Prospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Treatment Outcome</subject><ispartof>Transplantation, 2003-02, Vol.75 (4), p.454-461</ispartof><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14602031$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12605109$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>JUNGRAITHMAYR, Therese</creatorcontrib><creatorcontrib>STASKEWITZ, Astrid</creatorcontrib><creatorcontrib>KLAUS, Günter</creatorcontrib><creatorcontrib>LEICHTER, Heinz E</creatorcontrib><creatorcontrib>MIHATSCH, Michael J</creatorcontrib><creatorcontrib>MICHALK, Dietrich V</creatorcontrib><creatorcontrib>MISSELWITZ, Joachim</creatorcontrib><creatorcontrib>PLANK, Christian</creatorcontrib><creatorcontrib>QUERFELD, Uwe</creatorcontrib><creatorcontrib>WEBER, Lutz T</creatorcontrib><creatorcontrib>WIESEL, Manfred</creatorcontrib><creatorcontrib>TÖNSHOFF, Burkhard</creatorcontrib><creatorcontrib>KIRSTE, Günter</creatorcontrib><creatorcontrib>ZIMMERHACKL, Lothar B</creatorcontrib><creatorcontrib>BÖSWALD, Michael</creatorcontrib><creatorcontrib>BULLA, Monika</creatorcontrib><creatorcontrib>BURGHARD, Rainer</creatorcontrib><creatorcontrib>DIPPELL, Jürgen</creatorcontrib><creatorcontrib>GREINER, Christel</creatorcontrib><creatorcontrib>HELMCHEN, Udo</creatorcontrib><creatorcontrib>KLARE, Bernd</creatorcontrib><creatorcontrib>German Pediatric Renal Transplantation Study Group</creatorcontrib><title>Pediatric renal transplantation with mycophenolate mofetil-based immunosuppression without induction: Results after three years</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description>Mycophenolate mofetil (MMF)-based immunosuppression has reduced the acute rejection rate in adults and in children in the early posttransplantation period. Three-year posttransplantation results have been reported for adults but not for children thus far. In the present open-labeled study, patients 18 years old and younger were evaluated prospectively for up to 3 years after renal transplantation (RTX).
Eighty-six patients receiving MMF in combination with cyclosporine and prednisone without induction were evaluated for patient survival, transplant survival, renal function, arterial blood pressure, adverse events, and opportunistic infections. These patients were compared with a historic control group (n=54) receiving azathioprine (AZA) instead of MMF.
Patient survival after 3 years was 98.8% in the MMF group and 94.4% in the AZA group (NS). Intent-to-treat analysis of graft survival demonstrated superiority for MMF (98% vs. 80%; P<0.001). Cumulative acute rejection episodes occurred in 47% of patients in the MMF group versus 61% in the AZA group (P<0.05). Renal function was not significantly different, neither after 3 years nor in the long-term calculation. Antihypertensive medication was administered to 73% to 84% of patients, similar in both groups. Opportunistic infections were recorded only for MMF. Infection rates were comparable to those reported in adults.
These results suggest that MMF is safe and beneficial as a longer term maintenance immunosuppressive drug in children and adolescents.</description><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Azathioprine - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure</subject><subject>Child</subject><subject>Cyclosporine - administration & dosage</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft Rejection - drug therapy</subject><subject>Graft Rejection - mortality</subject><subject>Graft Survival - drug effects</subject><subject>Humans</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - therapy</subject><subject>Immunomodulators</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Kidney - physiology</subject><subject>Kidney Transplantation</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mycophenolic Acid - administration & dosage</subject><subject>Mycophenolic Acid - adverse effects</subject><subject>Mycophenolic Acid - analogs & derivatives</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Treatment Outcome</subject><issn>0041-1337</issn><issn>1534-6080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkEtLxDAUhYMozvj4CxIXumtNmjZJ3Yn4ggFFdF3S5IaJ9GWSIrPyr5vBEe_mLu53DvcchM4pySmpxRWh-dtLTrZTVqKUeV1JUea83ENLWrEy40SSfbRMZ5pRxsQCHYXwkfCKCXGIFrTgpEpWS_T9Asap6J3GHgbV4ejVEKZODVFFNw74y8U17jd6nNYwjJ2KgPvRQnRd1qoABru-n4cxzNPkIYQ_yThH7AYz663JNX6FMHcxYGUjeBzXHgBvQPlwgg6s6gKc7vYxer-_e7t9zFbPD0-3N6tsKriMGWhBuNAKrDQ6ZU7vC2lbKIzkupDCWq4qWhvO2raygpCiMqWhRkhojWTAjtHlr-_kx88ZQmx6FzR0KSiMc2ioFDUvijqBZztwbnswzeRdr_ym-assARc7QAWtOpv60i78cyUnBWGU_QCd4YFJ</recordid><startdate>20030227</startdate><enddate>20030227</enddate><creator>JUNGRAITHMAYR, Therese</creator><creator>STASKEWITZ, Astrid</creator><creator>KLAUS, Günter</creator><creator>LEICHTER, Heinz E</creator><creator>MIHATSCH, Michael J</creator><creator>MICHALK, Dietrich V</creator><creator>MISSELWITZ, Joachim</creator><creator>PLANK, Christian</creator><creator>QUERFELD, Uwe</creator><creator>WEBER, Lutz T</creator><creator>WIESEL, Manfred</creator><creator>TÖNSHOFF, Burkhard</creator><creator>KIRSTE, Günter</creator><creator>ZIMMERHACKL, Lothar B</creator><creator>BÖSWALD, Michael</creator><creator>BULLA, Monika</creator><creator>BURGHARD, Rainer</creator><creator>DIPPELL, Jürgen</creator><creator>GREINER, Christel</creator><creator>HELMCHEN, Udo</creator><creator>KLARE, Bernd</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>20030227</creationdate><title>Pediatric renal transplantation with mycophenolate mofetil-based immunosuppression without induction: Results after three years</title><author>JUNGRAITHMAYR, Therese ; STASKEWITZ, Astrid ; KLAUS, Günter ; LEICHTER, Heinz E ; MIHATSCH, Michael J ; MICHALK, Dietrich V ; MISSELWITZ, Joachim ; PLANK, Christian ; QUERFELD, Uwe ; WEBER, Lutz T ; WIESEL, Manfred ; TÖNSHOFF, Burkhard ; KIRSTE, Günter ; ZIMMERHACKL, Lothar B ; BÖSWALD, Michael ; BULLA, Monika ; BURGHARD, Rainer ; DIPPELL, Jürgen ; GREINER, Christel ; HELMCHEN, Udo ; KLARE, Bernd</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p268t-ec7067caef8dc45760578fbe2d86c287ff6a519d63bb5f70025d4d1d78ebd83e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Acute Disease</topic><topic>Adolescent</topic><topic>Azathioprine - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure</topic><topic>Child</topic><topic>Cyclosporine - administration & dosage</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft Rejection - drug therapy</topic><topic>Graft Rejection - mortality</topic><topic>Graft Survival - drug effects</topic><topic>Humans</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - therapy</topic><topic>Immunomodulators</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Kidney - physiology</topic><topic>Kidney Transplantation</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mycophenolic Acid - administration & dosage</topic><topic>Mycophenolic Acid - adverse effects</topic><topic>Mycophenolic Acid - analogs & derivatives</topic><topic>Pharmacology. Drug treatments</topic><topic>Prospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>JUNGRAITHMAYR, Therese</creatorcontrib><creatorcontrib>STASKEWITZ, Astrid</creatorcontrib><creatorcontrib>KLAUS, Günter</creatorcontrib><creatorcontrib>LEICHTER, Heinz E</creatorcontrib><creatorcontrib>MIHATSCH, Michael J</creatorcontrib><creatorcontrib>MICHALK, Dietrich V</creatorcontrib><creatorcontrib>MISSELWITZ, Joachim</creatorcontrib><creatorcontrib>PLANK, Christian</creatorcontrib><creatorcontrib>QUERFELD, Uwe</creatorcontrib><creatorcontrib>WEBER, Lutz T</creatorcontrib><creatorcontrib>WIESEL, Manfred</creatorcontrib><creatorcontrib>TÖNSHOFF, Burkhard</creatorcontrib><creatorcontrib>KIRSTE, Günter</creatorcontrib><creatorcontrib>ZIMMERHACKL, Lothar B</creatorcontrib><creatorcontrib>BÖSWALD, Michael</creatorcontrib><creatorcontrib>BULLA, Monika</creatorcontrib><creatorcontrib>BURGHARD, Rainer</creatorcontrib><creatorcontrib>DIPPELL, Jürgen</creatorcontrib><creatorcontrib>GREINER, Christel</creatorcontrib><creatorcontrib>HELMCHEN, Udo</creatorcontrib><creatorcontrib>KLARE, Bernd</creatorcontrib><creatorcontrib>German Pediatric Renal Transplantation Study Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>JUNGRAITHMAYR, Therese</au><au>STASKEWITZ, Astrid</au><au>KLAUS, Günter</au><au>LEICHTER, Heinz E</au><au>MIHATSCH, Michael J</au><au>MICHALK, Dietrich V</au><au>MISSELWITZ, Joachim</au><au>PLANK, Christian</au><au>QUERFELD, Uwe</au><au>WEBER, Lutz T</au><au>WIESEL, Manfred</au><au>TÖNSHOFF, Burkhard</au><au>KIRSTE, Günter</au><au>ZIMMERHACKL, Lothar B</au><au>BÖSWALD, Michael</au><au>BULLA, Monika</au><au>BURGHARD, Rainer</au><au>DIPPELL, Jürgen</au><au>GREINER, Christel</au><au>HELMCHEN, Udo</au><au>KLARE, Bernd</au><aucorp>German Pediatric Renal Transplantation Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric renal transplantation with mycophenolate mofetil-based immunosuppression without induction: Results after three years</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>2003-02-27</date><risdate>2003</risdate><volume>75</volume><issue>4</issue><spage>454</spage><epage>461</epage><pages>454-461</pages><issn>0041-1337</issn><eissn>1534-6080</eissn><coden>TRPLAU</coden><abstract>Mycophenolate mofetil (MMF)-based immunosuppression has reduced the acute rejection rate in adults and in children in the early posttransplantation period. Three-year posttransplantation results have been reported for adults but not for children thus far. In the present open-labeled study, patients 18 years old and younger were evaluated prospectively for up to 3 years after renal transplantation (RTX).
Eighty-six patients receiving MMF in combination with cyclosporine and prednisone without induction were evaluated for patient survival, transplant survival, renal function, arterial blood pressure, adverse events, and opportunistic infections. These patients were compared with a historic control group (n=54) receiving azathioprine (AZA) instead of MMF.
Patient survival after 3 years was 98.8% in the MMF group and 94.4% in the AZA group (NS). Intent-to-treat analysis of graft survival demonstrated superiority for MMF (98% vs. 80%; P<0.001). Cumulative acute rejection episodes occurred in 47% of patients in the MMF group versus 61% in the AZA group (P<0.05). Renal function was not significantly different, neither after 3 years nor in the long-term calculation. Antihypertensive medication was administered to 73% to 84% of patients, similar in both groups. Opportunistic infections were recorded only for MMF. Infection rates were comparable to those reported in adults.
These results suggest that MMF is safe and beneficial as a longer term maintenance immunosuppressive drug in children and adolescents.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>12605109</pmid><doi>10.1097/01.TP.0000045748.95874.64</doi><tpages>8</tpages></addata></record> |
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| ispartof | Transplantation, 2003-02, Vol.75 (4), p.454-461 |
| issn | 0041-1337 1534-6080 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Acute Disease Adolescent Azathioprine - administration & dosage Biological and medical sciences Blood Pressure Child Cyclosporine - administration & dosage Female Follow-Up Studies Graft Rejection - drug therapy Graft Rejection - mortality Graft Survival - drug effects Humans Hypertension - diagnosis Hypertension - therapy Immunomodulators Immunosuppressive Agents - administration & dosage Immunosuppressive Agents - adverse effects Kidney - physiology Kidney Transplantation Male Medical sciences Mycophenolic Acid - administration & dosage Mycophenolic Acid - adverse effects Mycophenolic Acid - analogs & derivatives Pharmacology. Drug treatments Prospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Treatment Outcome |
| title | Pediatric renal transplantation with mycophenolate mofetil-based immunosuppression without induction: Results after three years |
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