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A Prospective 3-yr Evaluation of Tacrolimus-based Immunosuppressive Therapy in Immunological High Risk Renal Allograft Recipients
Clinical Transplantation (2005)
  • Jeffrey S. Zaltzman
  • Anne Boucher
  • Stephan Busque
  • Phillip F. Halloran
  • David N. Landsberg
  • Vivian C. McAlister
  • David Russell
  • Ahmed Shoker
  • Jean Shapiro, University of British Columbia
  • Jean I. Tchervenkov
  • Ralph Ferguson

BACKGROUND: There have been no published data on use of the the newer immunosuppressants tacrolimus and mycophenolate mofetil (MMF) in high immunological risk renal transplantation. We therefore undertook a prospective study to systematically assess outcomes using these agents as part of an aggressive immunosuppressive regimen.

METHODS: Fifty-nine high-risk renal allograft recipients were enrolled at 10 Canadian sites and given a regimen of: a biological induction agent, tacrolimus, MMF, and corticosteroids. Patients included 10 (17%) who had lost a previous graft to rejection <1>yr, 31 (53%) with a current panel reactive antibody (PRA) >30%, 47 (80%) with a historic PRA >50%, four (7%) who had a positive historical T-cell crossmatch with the current donor, and six (10%) with a current positive B-cell crossmatch. The mean peak PRA was 76 +/- 33%.

RESULTS: The estimated 3-yr Kaplan-Meier patient and graft survival estimates were 89% and 75%, respectively. There were nine graft losses other than deaths with a functioning graft, of which six were preceded by delayed graft function (p = 0.01, chi2). Sixteen (27%) recipients experienced at least one episode of biopsy-confirmed acute rejection. Infections included cytomegalovirus in 16 patients, eight of whom had tissue-invasive disease. Only one malignancy occurred.

CONCLUSIONS: The immunosuppressive strategy investigated is effective and displays a satisfactory safety profile in high immunological risk renal allograft recipients.

  • Graft Rejection,
  • Graft Survival,
  • Immunosuppressive Agents,
  • Kidney Transplantation,
  • Prospective Studies,
  • Survival Analysis,
  • Tacrolimus,
  • Treatment Outcome
Publication Date
February, 2005
Publisher Statement
Dr. Vivian McAlister is currently a faculty member at The University of Western Ontario.
Citation Information
Jeffrey S. Zaltzman, Anne Boucher, Stephan Busque, Phillip F. Halloran, et al.. "A Prospective 3-yr Evaluation of Tacrolimus-based Immunosuppressive Therapy in Immunological High Risk Renal Allograft Recipients" Clinical Transplantation Vol. 19 Iss. 1 (2005)
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