Factors influencing glomerular filtration rate in renal transplantation after cyclosporine withdrawal using sirolimus-based therapy:: a multivariate analysis of results at five years

被引:21
作者
Legendre, Christophe
Brault, Yves
Morales, Jose M.
Oberbauer, Rainer
Altieri, Paolo
Riad, Hany
Mahony, John
Messina, Maria
Pussell, Bruce
Martinez, Javier G.
Lelong, Magali
Burke, James T.
Neylan, John F.
机构
[1] Hop Necker Enfants Malad, Serv Transplantat & Soins Intens Nephrol, F-75747 Paris, France
[2] Wyeth Ayerst Res, Paris, France
[3] Hosp 12 Octubre, E-28041 Madrid, Spain
[4] Allgemeines Krankenhaus Wien, Vienna, Austria
[5] Osped S Michele, Cagliari, Italy
[6] Manchester Royal Infirm, Manchester M13 9WL, Lancs, England
[7] Royal N Shore Hosp, St Leonards, NSW 2065, Australia
[8] Osped S Giovanni Torino, Turin, Italy
[9] Prince Wales Hosp, Randwick, NSW 2031, Australia
[10] Hosp La Fe, E-46009 Valencia, Spain
[11] Wyeth Ayerst Res, Collegeville, PA USA
关键词
cyclosporine withdrawal; glomerular filtration rate; multivariate analysis; sirolimus;
D O I
10.1111/j.1399-0012.2007.00645.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Changes in calculated glomerular filtration rate (GFR) from baseline to five yr were analyzed in relation to risk factors among renal transplant recipients. At three months after transplantation (baseline), 430 eligible patients receiving sirolimus (SRL), cyclosporine (CsA), and steroids (ST) were randomly assigned (1:1) to continue SRL-CsA-ST or have CsA withdrawn and SRL trough levels increased (SRL-ST group). For each risk factor, changes from baseline were compared within each treatment using a t-test and between treatments using ANCOVA. Univariate then multivariate robust linear regression analyses were also performed. In the SRL-ST group, changes from baseline were not significantly different for any risk factor. With the exception of cold ischemia time > 24 h, GFR values declined significantly for all risk factors in SRL-CsA-ST patients. For all risk factors, except second transplant or cold ischemia time > 24 h, renal function was significantly different between groups. By order of significance in the multivariate analysis, treatment (p < 0.001), donor age (p < 0.001), proteinuria (p < 0.001), and biopsy-confirmed rejection (p = 0.010) were significant predictors of GFR change from baseline. In conclusion, patients with risk factors for reduced renal function benefit from SRL maintenance therapy without CsA vs. those remaining on CsA.
引用
收藏
页码:330 / 336
页数:7
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