PMID- 24414376
OWN - NLM
STAT- MEDLINE
DCOM- 20141107
LR  - 20220316
IS  - 1460-2385 (Electronic)
IS  - 0931-0509 (Print)
IS  - 0931-0509 (Linking)
VI  - 29
IP  - 1
DP  - 2014 Jan
TI  - Calcineurin inhibitors in HLA-identical living related donor kidney 
      transplantation.
PG  - 209-18
LID - 10.1093/ndt/gft447 [doi]
AB  - BACKGROUND: Given the nephrotoxicity of calcineurin inhibitors (CNIs), we asked 
      whether their addition improved living related donor (LRD) human leukocyte 
      antigen (HLA) identical kidney transplant recipient outcomes. METHODS: We 
      performed a comprehensive literature review and a single-center study comparing 
      patient survival (PS) and graft survival (GS) of LRD HLA-identical kidney 
      transplants for three different immunosuppression eras: Era 1 (up to 1984): 
      anti-lymphocyte globulin (ALG) induction and maintenance immunosuppression with 
      prednisone and azathioprine (AZA) (n = 114); Era 2a (1984-99): CNI added; 
      evolution from ALG to thymoglobulin; AZA to mycophenolate (n = 262). Era 2b 
      (1999-2011): rapid discontinuation of prednisone (thymoglobulin induction, CNI 
      and mycophenolate) in recipients having first or second transplant and not 
      previously on prednisone (n = 77). RESULTS: Demographics differed by era: 
      recipient (P < 0.0001) and donor age (P < 0.0001) increased and the proportion of 
      Caucasian donors (P = 0.02) and recipients (P = 0.003) decreased with each 
      advancing era. There was no significant difference in PS (P = 0.6); cause of 
      death (P = 0.5); death-censored GS (P = 0.8) or graft loss from acute rejection 
      by era. Graft loss from chronic allograft nephropathy (P = 0.02) and hypertension 
      (P = 0.005) were greater in the CNI eras. There were no significant differences 
      in the 1/creatinine slopes between eras for the first (P = 0.6), second (P = 0.9) 
      or >2 years post-transplant (P = 0.4). Literature review revealed no clear 
      benefits for CNI in these human leukocyte antigen (HLA) identical LRD graft 
      recipients. CONCLUSIONS: This study confirmed that there are no benefits of CNIs 
      for HLA-identical LRD recipients. Moreover, we did find evidence of potential 
      harm. Thus, monotherapy or early discontinuation of CNI should be given 
      consideration in these patients.
FAU - Verghese, Priya S
AU  - Verghese PS
AD  - Department of Pediatrics, University of Minnesota Medical School, Minneapolis, 
      MN, USA.
FAU - Dunn, Ty B
AU  - Dunn TB
FAU - Chinnakotla, Srinath
AU  - Chinnakotla S
FAU - Gillingham, Kristin J
AU  - Gillingham KJ
FAU - Matas, Arthur J
AU  - Matas AJ
FAU - Mauer, Michael S
AU  - Mauer MS
LA  - eng
GR  - P01 DK013083/DK/NIDDK NIH HHS/United States
GR  - DK013083/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Review
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (Calcineurin Inhibitors)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
RN  - 83HN0GTJ6D (Cyclosporine)
RN  - AYI8EX34EU (Creatinine)
RN  - MRK240IY2L (Azathioprine)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Antilymphocyte Serum/immunology
MH  - Azathioprine/therapeutic use
MH  - *Calcineurin Inhibitors
MH  - Child
MH  - Creatinine/metabolism
MH  - Cyclosporine/therapeutic use
MH  - Female
MH  - Graft Rejection/immunology/*prevention & control
MH  - Graft Survival/immunology
MH  - *HLA Antigens
MH  - Humans
MH  - Immunosuppressive Agents/adverse effects/therapeutic use
MH  - *Kidney Transplantation/mortality
MH  - *Living Donors
MH  - Male
MH  - Middle Aged
MH  - Tacrolimus/therapeutic use
MH  - Young Adult
PMC - PMC3888312
OTO - NOTNLM
OT  - HLA identical
OT  - calcineurin inhibitors
OT  - cyclosporine
OT  - renal transplant
OT  - tacrolimus
EDAT- 2014/01/15 06:00
MHDA- 2014/11/08 06:00
PMCR- 2015/01/01
CRDT- 2014/01/14 06:00
PHST- 2014/01/14 06:00 [entrez]
PHST- 2014/01/15 06:00 [pubmed]
PHST- 2014/11/08 06:00 [medline]
PHST- 2015/01/01 00:00 [pmc-release]
AID - gft447 [pii]
AID - 10.1093/ndt/gft447 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2014 Jan;29(1):209-18. doi: 10.1093/ndt/gft447.