Long-term outcome of renal transplantation: a 10-year follow-up of 765 recipients.
Pol Arch Intern Med
; 129(7-8): 476-483, 2019 08 29.
Article
en En
| MEDLINE
| ID: mdl-31379358
ABSTRACT
INTRODUCTION:
Renal transplantation is a treatment of choice for patients with endstage renal disease. The main goal of transplant care is to achieve the best longterm patient survival (PS) and graft survival (GS).OBJECTIVES:
We aimed to assess the impact of various immunosuppression (IS) protocols on PS and GS following renal transplantation. PATIENTS ANDMETHODS:
This was a retrospective singlecenter cohort study including a total of 765 consecutive adult renal transplant recipients (RTRs) who underwent transplantation between 1998 and 2003. The primary endpoints included PS and GS. The secondary endpoints were graft function determined by estimated glomerular filtration rate and hospitalization length per patient per year.RESULTS:
Tenyear PS and GS rates were 88.6% and 78.7%, respectively. The intenttotreat (ITT) group received IS that was later changed, whereas in the group on randomized therapy (ORT), the same IS protocol was maintained during followup. The ITT group had significantly better PS and GS than the ORT group. In the ITT group, patients treated with a combination of tacrolimus (TAC) and azathioprine (AZA), cyclosporine (CSA) and AZA, or CSA and mycophenolic acid metabolites (MPAs) had significantly better PS than those treated with TAC and MPA. The ORT group receiving AZA in any combination also had significantly better PS than MPAtreated individuals.CONCLUSIONS:
The effect of IS protocols on longterm outcomes varies depending on patient subpopulations. Immunosuppressive therapy solves rejectionrelated problems but does not address the increasing mortality of RTRs due to cardiovascular diseases, malignancies, or infections. Therefore, treatment recommendations should be individualized and posttransplant care, provided mainly by internists, should be carefully structured to improve longterm outcomes of renal transplantation.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Trasplante de Riñón
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Rechazo de Injerto
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Supervivencia de Injerto
Tipo de estudio:
Etiology_studies
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Guideline
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Pol Arch Intern Med
Año:
2019
Tipo del documento:
Article
País de afiliación:
Polonia