Function of Transplanted Kidney after Ten Years of Tacrolismus

The follow up has shown that immunosuppression with Prograf, with early discontinuation of corticoid treatment, in combination with mycophenolate mophetil brings from the long-term point of view very good survival and transplanted kidney function results and benefits transplant patients.

The Function of Transplanted Kidney after Ten Years of Tacrolismus (PROGRAF) Immunisuppression wtih Discontinuation of Corticoids

Milan Kuman M.D., P.Studeník M.D., V.Mejzlík M.D., K.Trnavský M.D., J.Ondrášek M.D., P.Němec M.D.,PhD.

Introduction : The first 18 patients treated with Prograf at our centre were subject to long-term follow-up.

Patient group:18 patients, of whom 5 women and 13 men after the first kidney transplant, recieved immunosuppressant treatment with tacrolimus, corticoids and, on randomised basis, with azathioprine from 1999 to 2000 (9 patients, i.e. 50%), or with mycophenolate (9 patients, i.e. 50%). Corticoid treatment was discontinued at four months post-transplant. Patients were monitored for ten years. Two of the monitored patients were later transferred from Prograf to Neoral (cyclosporine A) due to neurotoxicity . 16 patients, i.e. 89%, continued on Prograf therapy. All patients with functioning graft at year ten was on Prograf and corticoidfree.

Objective:To establish long-term patient survival and quality of function of the kidney graft.

Results:14 patients completed the ten-year follow up – the survival rate being 77.8%. Four patients with functional graft died before the end of the follow up period – 22.2% mortality (lx colorectal carcinoma, lx Grawitz tumor, lx lung embolia, lx mesenteric artery thrombosis). Kidney grafts ceased to function and haemodialysis was renewed in three patients only, i.e. in 16.6%. (2x IgA nephropathy, lx CAN). 11 kidney grafts, i.e. 61%, were functional after ten years of transplant. Rejection episodes ( all in first year) were also documented (7 episodes on the total, i.e. 39%, of which 5 corticosensitive, i.e. 28%, and 2 corticoresistant, i.e. 11%, ). More in the branch using azathioprine (5 corticosensitive, i.e. 55%, and 2 corticoresistant, i.e. 22%). The quality of graft function was assessed by comparison of trends in values of creatininemia ( at year ten 139.7 ± 33,4 umol/l) and glomerular filtration ( at year ten 1.090 ± 0.37 ml/s ).

Conclusion:The follow up has shown that immunosuppression with Prograf, with early discontinuation of corticoid treatment, in combination with mycophenolate mophetil brings from the long-term point of view very good survival and transplanted kidney function results and benefits transplant patients.

Milan Kuman M.D.
Transplant unit Tel.:+ 420-5-4318 2544 Fax: +420-5-4318 2541 Mob:+420-723 024 466
E-mail: milankuman@cktch.cz

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