Tacrolimus combined with mycophenolate mofetil can effectively reverse C4d-positive steroid-resistant acute rejection in Chinese renal allograft recipients
Background. Tacrolimus (TAC) combined with mycophenolate mofetil (MMF) has been suggested to play a critical role in the reversal of C4d-positive acute humoral rejection (AHR) in renal transplantation, but the efficacy of using only TAC–MMF without immunoadsorption or plasmapheresis has not been inv...
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| Veröffentlicht in: | Nephrology, dialysis, transplantation dialysis, transplantation, 2006-02, Vol.21 (2), p.510-517 |
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| creator | Sun, Qiquan Liu, Zhi-Hong Yin, Guang Chen, Huiping Chen, Jinsong Ji, Shuming Li, Lei-Shi |
| description | Background. Tacrolimus (TAC) combined with mycophenolate mofetil (MMF) has been suggested to play a critical role in the reversal of C4d-positive acute humoral rejection (AHR) in renal transplantation, but the efficacy of using only TAC–MMF without immunoadsorption or plasmapheresis has not been investigated. On the other hand, Chinese recipients of renal grafts usually need lower doses of immunosuppressants, and their optimal treatment for acute humoral rejection has not been established. Methods. Since 1999, we have used TAC–MMF to treat steroid-resistant acute rejection (AR). C4d staining was retrospectively performed in 32 patients with steroid-resistant AR, and the treatments of 19 patients with C4d-positive steroid-resistant AR were investigated. Results. Thirteen of 19 patients received TAC–MMF treatment only; 11 episodes of rejection in them were reversed (7 completely, 4 partially) and only 2 recipients lost their graft. Another 6 patients received immunoadsorption also. One of them failed to be converted to TAC-MMF and lost her graft. Four of 5 patients treated with immunoadsorption and TAC–MMF recovered (3 completely, 1 partially), but 3 of them had severe pneumonia, a complication rate statistically higher than in patients treated with only TAC–MMF (P |
| doi_str_mv | 10.1093/ndt/gfk027 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70672301</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1006980531</sourcerecordid><originalsourceid>FETCH-LOGICAL-c447t-f9a983647d78f1935479a19f5d4780cbccd9874efc2c83c926fa2088ee2af5113</originalsourceid><addsrcrecordid>eNqFkt9qFDEUhwdRbK3e-AASBL0QxubPzCS5lEVboahIhdKbkM2cdLPNJNskU91n8WXNsosFb7wKOefL7yR8aZqXBL8nWLLTMJbTG3uLKX_UHJNuwC1lon_cHNcmaXGP5VHzLOc1xlhSzp82R2ToKCHDcNz8vtQmRe-mOSMTp6ULMKKfrqzQtDVxs4IQvS6ApmihOI-MDgisBVPcPfgtSnAPKQNadGO7idntyigXSNGNbYLsctGhIG3mGpJgvTsYA3IBLVZ1Vt4Vg_ZIex9vkral7o3bOAglP2-eWO0zvDisJ82PTx8vF-ftxdezz4sPF63pOl5aK7UUbOj4yIUlkvUdl5pI248dF9gsjRml4B1YQ41gRtLBaoqFAKDa9oSwk-btPneT4t0MuajJZQPe6wBxzorjgVOG_w8S3gnMBa3g63_AdZxTfWdWlAjC5NCLCr3bQ1VAzgms2iQ36bRVBKudWFXFqr3YCr86JM7LCcYH9GCyAm8OgM5Ge5t0MC4_cLx-g57trtbuuWoGfv3t63SrBs54r86vrtX14psgZ9-v1Bf2By_YvwM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>218139658</pqid></control><display><type>article</type><title>Tacrolimus combined with mycophenolate mofetil can effectively reverse C4d-positive steroid-resistant acute rejection in Chinese renal allograft recipients</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Sun, Qiquan ; Liu, Zhi-Hong ; Yin, Guang ; Chen, Huiping ; Chen, Jinsong ; Ji, Shuming ; Li, Lei-Shi</creator><creatorcontrib>Sun, Qiquan ; Liu, Zhi-Hong ; Yin, Guang ; Chen, Huiping ; Chen, Jinsong ; Ji, Shuming ; Li, Lei-Shi</creatorcontrib><description>Background. Tacrolimus (TAC) combined with mycophenolate mofetil (MMF) has been suggested to play a critical role in the reversal of C4d-positive acute humoral rejection (AHR) in renal transplantation, but the efficacy of using only TAC–MMF without immunoadsorption or plasmapheresis has not been investigated. On the other hand, Chinese recipients of renal grafts usually need lower doses of immunosuppressants, and their optimal treatment for acute humoral rejection has not been established. Methods. Since 1999, we have used TAC–MMF to treat steroid-resistant acute rejection (AR). C4d staining was retrospectively performed in 32 patients with steroid-resistant AR, and the treatments of 19 patients with C4d-positive steroid-resistant AR were investigated. Results. Thirteen of 19 patients received TAC–MMF treatment only; 11 episodes of rejection in them were reversed (7 completely, 4 partially) and only 2 recipients lost their graft. Another 6 patients received immunoadsorption also. One of them failed to be converted to TAC-MMF and lost her graft. Four of 5 patients treated with immunoadsorption and TAC–MMF recovered (3 completely, 1 partially), but 3 of them had severe pneumonia, a complication rate statistically higher than in patients treated with only TAC–MMF (P<0.05). AR occurring during the first two weeks after transplantation had a statistically better outcome than that occurring later (P = 0.003). Conclusion. Our study suggests that the combination of TAC and MMF is a potentially safe and economic treatment for most Chinese renal allograft recipients with C4d-positive steroid-resistant AR, especially for rejections developing within the first two weeks after transplantation.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfk027</identifier><identifier>PMID: 16421166</identifier><identifier>CODEN: NDTREA</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Acute Disease ; acute rejection ; Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; C4d ; CD4 Antigens - immunology ; China ; Drug Resistance ; Drug Therapy, Combination ; Emergency and intensive care: renal failure. Dialysis management ; Female ; Glucocorticoids - therapeutic use ; Graft Rejection - drug therapy ; Graft Rejection - immunology ; Humans ; Immunosuppressive Agents - administration & dosage ; Intensive care medicine ; Kidney Transplantation ; Male ; Medical sciences ; Methylprednisolone - therapeutic use ; Middle Aged ; mycophenolate mofetil ; Mycophenolic Acid - administration & dosage ; Mycophenolic Acid - analogs & derivatives ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Remission Induction ; Renal failure ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; tacrolimus ; Tacrolimus - administration & dosage</subject><ispartof>Nephrology, dialysis, transplantation, 2006-02, Vol.21 (2), p.510-517</ispartof><rights>2006 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Feb 2006</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-f9a983647d78f1935479a19f5d4780cbccd9874efc2c83c926fa2088ee2af5113</citedby><cites>FETCH-LOGICAL-c447t-f9a983647d78f1935479a19f5d4780cbccd9874efc2c83c926fa2088ee2af5113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17509532$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16421166$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sun, Qiquan</creatorcontrib><creatorcontrib>Liu, Zhi-Hong</creatorcontrib><creatorcontrib>Yin, Guang</creatorcontrib><creatorcontrib>Chen, Huiping</creatorcontrib><creatorcontrib>Chen, Jinsong</creatorcontrib><creatorcontrib>Ji, Shuming</creatorcontrib><creatorcontrib>Li, Lei-Shi</creatorcontrib><title>Tacrolimus combined with mycophenolate mofetil can effectively reverse C4d-positive steroid-resistant acute rejection in Chinese renal allograft recipients</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol. Dial. Transplant</addtitle><description>Background. Tacrolimus (TAC) combined with mycophenolate mofetil (MMF) has been suggested to play a critical role in the reversal of C4d-positive acute humoral rejection (AHR) in renal transplantation, but the efficacy of using only TAC–MMF without immunoadsorption or plasmapheresis has not been investigated. On the other hand, Chinese recipients of renal grafts usually need lower doses of immunosuppressants, and their optimal treatment for acute humoral rejection has not been established. Methods. Since 1999, we have used TAC–MMF to treat steroid-resistant acute rejection (AR). C4d staining was retrospectively performed in 32 patients with steroid-resistant AR, and the treatments of 19 patients with C4d-positive steroid-resistant AR were investigated. Results. Thirteen of 19 patients received TAC–MMF treatment only; 11 episodes of rejection in them were reversed (7 completely, 4 partially) and only 2 recipients lost their graft. Another 6 patients received immunoadsorption also. One of them failed to be converted to TAC-MMF and lost her graft. Four of 5 patients treated with immunoadsorption and TAC–MMF recovered (3 completely, 1 partially), but 3 of them had severe pneumonia, a complication rate statistically higher than in patients treated with only TAC–MMF (P<0.05). AR occurring during the first two weeks after transplantation had a statistically better outcome than that occurring later (P = 0.003). Conclusion. Our study suggests that the combination of TAC and MMF is a potentially safe and economic treatment for most Chinese renal allograft recipients with C4d-positive steroid-resistant AR, especially for rejections developing within the first two weeks after transplantation.</description><subject>Acute Disease</subject><subject>acute rejection</subject><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>C4d</subject><subject>CD4 Antigens - immunology</subject><subject>China</subject><subject>Drug Resistance</subject><subject>Drug Therapy, Combination</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Graft Rejection - drug therapy</subject><subject>Graft Rejection - immunology</subject><subject>Humans</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Intensive care medicine</subject><subject>Kidney Transplantation</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Methylprednisolone - therapeutic use</subject><subject>Middle Aged</subject><subject>mycophenolate mofetil</subject><subject>Mycophenolic Acid - administration & dosage</subject><subject>Mycophenolic Acid - analogs & derivatives</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Remission Induction</subject><subject>Renal failure</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>tacrolimus</subject><subject>Tacrolimus - administration & dosage</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkt9qFDEUhwdRbK3e-AASBL0QxubPzCS5lEVboahIhdKbkM2cdLPNJNskU91n8WXNsosFb7wKOefL7yR8aZqXBL8nWLLTMJbTG3uLKX_UHJNuwC1lon_cHNcmaXGP5VHzLOc1xlhSzp82R2ToKCHDcNz8vtQmRe-mOSMTp6ULMKKfrqzQtDVxs4IQvS6ApmihOI-MDgisBVPcPfgtSnAPKQNadGO7idntyigXSNGNbYLsctGhIG3mGpJgvTsYA3IBLVZ1Vt4Vg_ZIex9vkral7o3bOAglP2-eWO0zvDisJ82PTx8vF-ftxdezz4sPF63pOl5aK7UUbOj4yIUlkvUdl5pI248dF9gsjRml4B1YQ41gRtLBaoqFAKDa9oSwk-btPneT4t0MuajJZQPe6wBxzorjgVOG_w8S3gnMBa3g63_AdZxTfWdWlAjC5NCLCr3bQ1VAzgms2iQ36bRVBKudWFXFqr3YCr86JM7LCcYH9GCyAm8OgM5Ge5t0MC4_cLx-g57trtbuuWoGfv3t63SrBs54r86vrtX14psgZ9-v1Bf2By_YvwM</recordid><startdate>20060201</startdate><enddate>20060201</enddate><creator>Sun, Qiquan</creator><creator>Liu, Zhi-Hong</creator><creator>Yin, Guang</creator><creator>Chen, Huiping</creator><creator>Chen, Jinsong</creator><creator>Ji, Shuming</creator><creator>Li, Lei-Shi</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20060201</creationdate><title>Tacrolimus combined with mycophenolate mofetil can effectively reverse C4d-positive steroid-resistant acute rejection in Chinese renal allograft recipients</title><author>Sun, Qiquan ; Liu, Zhi-Hong ; Yin, Guang ; Chen, Huiping ; Chen, Jinsong ; Ji, Shuming ; Li, Lei-Shi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c447t-f9a983647d78f1935479a19f5d4780cbccd9874efc2c83c926fa2088ee2af5113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Acute Disease</topic><topic>acute rejection</topic><topic>Adult</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>C4d</topic><topic>CD4 Antigens - immunology</topic><topic>China</topic><topic>Drug Resistance</topic><topic>Drug Therapy, Combination</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Female</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Graft Rejection - drug therapy</topic><topic>Graft Rejection - immunology</topic><topic>Humans</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Intensive care medicine</topic><topic>Kidney Transplantation</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Methylprednisolone - therapeutic use</topic><topic>Middle Aged</topic><topic>mycophenolate mofetil</topic><topic>Mycophenolic Acid - administration & dosage</topic><topic>Mycophenolic Acid - analogs & derivatives</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Remission Induction</topic><topic>Renal failure</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>tacrolimus</topic><topic>Tacrolimus - administration & dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sun, Qiquan</creatorcontrib><creatorcontrib>Liu, Zhi-Hong</creatorcontrib><creatorcontrib>Yin, Guang</creatorcontrib><creatorcontrib>Chen, Huiping</creatorcontrib><creatorcontrib>Chen, Jinsong</creatorcontrib><creatorcontrib>Ji, Shuming</creatorcontrib><creatorcontrib>Li, Lei-Shi</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sun, Qiquan</au><au>Liu, Zhi-Hong</au><au>Yin, Guang</au><au>Chen, Huiping</au><au>Chen, Jinsong</au><au>Ji, Shuming</au><au>Li, Lei-Shi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tacrolimus combined with mycophenolate mofetil can effectively reverse C4d-positive steroid-resistant acute rejection in Chinese renal allograft recipients</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol. Dial. Transplant</addtitle><date>2006-02-01</date><risdate>2006</risdate><volume>21</volume><issue>2</issue><spage>510</spage><epage>517</epage><pages>510-517</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><coden>NDTREA</coden><abstract>Background. Tacrolimus (TAC) combined with mycophenolate mofetil (MMF) has been suggested to play a critical role in the reversal of C4d-positive acute humoral rejection (AHR) in renal transplantation, but the efficacy of using only TAC–MMF without immunoadsorption or plasmapheresis has not been investigated. On the other hand, Chinese recipients of renal grafts usually need lower doses of immunosuppressants, and their optimal treatment for acute humoral rejection has not been established. Methods. Since 1999, we have used TAC–MMF to treat steroid-resistant acute rejection (AR). C4d staining was retrospectively performed in 32 patients with steroid-resistant AR, and the treatments of 19 patients with C4d-positive steroid-resistant AR were investigated. Results. Thirteen of 19 patients received TAC–MMF treatment only; 11 episodes of rejection in them were reversed (7 completely, 4 partially) and only 2 recipients lost their graft. Another 6 patients received immunoadsorption also. One of them failed to be converted to TAC-MMF and lost her graft. Four of 5 patients treated with immunoadsorption and TAC–MMF recovered (3 completely, 1 partially), but 3 of them had severe pneumonia, a complication rate statistically higher than in patients treated with only TAC–MMF (P<0.05). AR occurring during the first two weeks after transplantation had a statistically better outcome than that occurring later (P = 0.003). Conclusion. Our study suggests that the combination of TAC and MMF is a potentially safe and economic treatment for most Chinese renal allograft recipients with C4d-positive steroid-resistant AR, especially for rejections developing within the first two weeks after transplantation.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>16421166</pmid><doi>10.1093/ndt/gfk027</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Nephrology, dialysis, transplantation, 2006-02, Vol.21 (2), p.510-517 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Acute Disease acute rejection Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences C4d CD4 Antigens - immunology China Drug Resistance Drug Therapy, Combination Emergency and intensive care: renal failure. Dialysis management Female Glucocorticoids - therapeutic use Graft Rejection - drug therapy Graft Rejection - immunology Humans Immunosuppressive Agents - administration & dosage Intensive care medicine Kidney Transplantation Male Medical sciences Methylprednisolone - therapeutic use Middle Aged mycophenolate mofetil Mycophenolic Acid - administration & dosage Mycophenolic Acid - analogs & derivatives Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Remission Induction Renal failure Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system tacrolimus Tacrolimus - administration & dosage |
| title | Tacrolimus combined with mycophenolate mofetil can effectively reverse C4d-positive steroid-resistant acute rejection in Chinese renal allograft recipients |
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