PMID- 19758267
OWN - NLM
STAT- MEDLINE
DCOM- 20110201
LR  - 20161125
IS  - 1399-0012 (Electronic)
IS  - 0902-0063 (Linking)
VI  - 24
IP  - 4
DP  - 2010 Jul-Aug
TI  - Acute rejection in low-toxicity regimens: clinical impact and risk factors in the 
      Symphony study.
PG  - 500-9
LID - 10.1111/j.1399-0012.2009.01093.x [doi]
AB  - The Symphony study assessed whether mycophenolate mofetil (MMF)-based regimens 
      containing reduced doses of adjunct immunosuppressants could reduce toxicity 
      while maintaining efficacy. Here, we examined the impact of acute rejection and 
      associated risk factors. The incidence of biopsy-proven acute rejection in the 
      low-dose tacrolimus group was approximately half that of the standard-dose 
      cyclosporine and low-dose cyclosporine groups, and a third of that in the 
      low-dose sirolimus group. The low-dose cyclosporine group had more severe 
      rejection episodes (>/=grade II) compared with other groups. Acute rejection was 
      associated with a 10 mL/min glomerular filtration rate (GFR) reduction and a 5.3% 
      absolute increase in graft loss at 12 months. Overall, the highest GFR was found 
      in both rejecters and non-rejecters receiving low-dose tacrolimus, both in an 
      intent-to-treat analysis and in patients successfully treated according to the 
      protocol. In Cox regression models, human leukocyte antigen (HLA) mismatches and 
      expanded criteria donors increased the acute rejection risk, while recipient age, 
      living related donor, and MMF dose were associated with a reduced risk. Acute 
      rejection was associated with worse outcome but did not entirely explain the 
      differences among the treatment groups. The 2 g MMF plus low-dose tacrolimus 
      combination appears to be the most efficient of all regimens examined regardless 
      of acute rejection.
CI  - (c) 2009 John Wiley & Sons A/S.
FAU - Frei, Ulrich
AU  - Frei U
AD  - Department of Nephrology and Medical Intensive Care, Charite, Virchow-Klinikum, 
      Berlin, Germany.
FAU - Daloze, Pierre
AU  - Daloze P
FAU - Vitko, Stefan
AU  - Vitko S
FAU - Klempnauer, Jurgen
AU  - Klempnauer J
FAU - Reyes-Acevedo, Rafael
AU  - Reyes-Acevedo R
FAU - Titiz, Izzet
AU  - Titiz I
FAU - Fricke, Lutz
AU  - Fricke L
FAU - Bernasconi, Corrado
AU  - Bernasconi C
FAU - Ekberg, Henrik
AU  - Ekberg H
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - Denmark
TA  - Clin Transplant
JT  - Clinical transplantation
JID - 8710240
RN  - 0 (Immunosuppressive Agents)
RN  - 83HN0GTJ6D (Cyclosporine)
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - W36ZG6FT64 (Sirolimus)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Acute Disease
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Cyclosporine/therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Glomerular Filtration Rate
MH  - Graft Rejection/*prevention & control
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Incidence
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - Mycophenolic Acid/analogs & derivatives/therapeutic use
MH  - Risk Factors
MH  - Sirolimus/therapeutic use
MH  - Tacrolimus/therapeutic use
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2009/09/18 06:00
MHDA- 2011/02/02 06:00
CRDT- 2009/09/18 06:00
PHST- 2009/09/18 06:00 [entrez]
PHST- 2009/09/18 06:00 [pubmed]
PHST- 2011/02/02 06:00 [medline]
AID - CTR1093 [pii]
AID - 10.1111/j.1399-0012.2009.01093.x [doi]
PST - ppublish
SO  - Clin Transplant. 2010 Jul-Aug;24(4):500-9. doi: 10.1111/j.1399-0012.2009.01093.x.