Sirolimus in chronic allograft nephropathy in pediatric recipients
Identifieur interne : 007454 ( Main/Exploration ); précédent : 007453; suivant : 007455Sirolimus in chronic allograft nephropathy in pediatric recipients
Auteurs : J. P. Ibá Ez [Argentine] ; M. L. Monteverde [Argentine] ; M. A. Diaz [Argentine] ; J. Goldberg [Argentine] ; A. F. Turconi [Argentine]Source :
- Pediatric Transplantation [ 1397-3142 ] ; 2007-11.
Descripteurs français
- KwdFr :
- Association de médicaments, Biopsie, Cholestérol (sang), Complications postopératoires (immunologie), Complications postopératoires (traitement médicamenteux), Enfant, Humains, Immunosuppresseurs (effets indésirables), Immunosuppresseurs (usage thérapeutique), Numération des plaquettes, Protéinurie (urine), Sirolimus (effets indésirables), Sirolimus (usage thérapeutique), Sécurité, Taux de filtration glomérulaire (), Transplantation homologue, Transplantation rénale (anatomopathologie), Transplantation rénale (immunologie), Transplantation rénale (physiologie), Triglycéride (sang), Études rétrospectives.
- MESH :
- anatomopathologie : Transplantation rénale.
- effets indésirables : Immunosuppresseurs, Sirolimus.
- immunologie : Complications postopératoires, Transplantation rénale.
- physiologie : Transplantation rénale.
- sang : Cholestérol, Triglycéride.
- traitement médicamenteux : Complications postopératoires.
- usage thérapeutique : Immunosuppresseurs, Protéinurie, Sirolimus.
- Association de médicaments, Biopsie, Enfant, Humains, Numération des plaquettes, Sécurité, Taux de filtration glomérulaire, Transplantation homologue, Études rétrospectives.
English descriptors
- KwdEn :
- Biopsy, Child, Cholesterol (blood), Drug Therapy, Combination, Glomerular Filtration Rate (drug effects), Humans, Immunosuppressive Agents (adverse effects), Immunosuppressive Agents (therapeutic use), Kidney Transplantation (immunology), Kidney Transplantation (pathology), Kidney Transplantation (physiology), Platelet Count, Postoperative Complications (drug therapy), Postoperative Complications (immunology), Proteinuria (urine), Retrospective Studies, Safety, Sirolimus (adverse effects), Sirolimus (therapeutic use), Transplantation, Homologous, Triglycerides (blood).
- MESH :
- chemical , adverse effects : Immunosuppressive Agents, Sirolimus.
- chemical , blood : Cholesterol, Triglycerides.
- drug effects : Glomerular Filtration Rate.
- drug therapy : Postoperative Complications.
- immunology : Kidney Transplantation, Postoperative Complications.
- pathology : Kidney Transplantation.
- physiology : Kidney Transplantation.
- chemical , therapeutic use : Immunosuppressive Agents, Sirolimus.
- urine : Proteinuria.
- Biopsy, Child, Drug Therapy, Combination, Humans, Platelet Count, Retrospective Studies, Safety, Transplantation, Homologous.
Abstract
Abstract: CAN is a common cause of late graft loss. Nephrotoxicity due to CNIs is known to contribute to CAN. We retrospectively evaluated the efficacy and safety of SRL in pediatric renal Tx recipients showing CAN in their allograft biopsy. Twenty‐one patients aged 10.4 ± 4.6 yr at Tx time receiving CNIs as primary immunosuppression were converted to SRL at 58.9 ± 49.1 months after Tx, due to progressive decline of renal function and biopsy proven CAN. Mean follow‐up after switch was 19.7 ± 9.5 months. All patients received CsA as part of the immunosuppressive regimen, at a mean dose 4.4 ± 1.2 mg/kg/day. Mean daily dose of SRL three month after conversion was 2.6 ± 0.8 mg/body surface area/day and the mean through levels where 6.9 ± 2.5 ng/mL. Graft biopsies showed Grade I CAN in 12 children and Grade II CAN in nine. After SRL introduction, there were neither acute rejection episodes nor graft losses. GFR improved at three months and was sustained thereafter only in children with Grade I CAN. Post‐Tx time at conversion was the only significant variable between patients who had Grade I CAN and Grade II CAN (33.6 ± 33.3 vs. 92.7 ± 47.5 months, p = 0.003). Nine patients had no AEs, six patients had nine SAE: five diarrhea, one herpes zoster, one pancreatic pseudo cyst, one pneumonia, and one Influenza A infection; 11 patients had 13 AEs: six oral aphthous ulcers, three urinary tract infections, two herpes simplex, one lymphedema, and one nephrotic proteinuria. Significant improvement of GFR occurred in Grade I CAN group at three months from conversion and was sustained during follow‐up. Those who had Grade II CAN experienced no change in GFR. The incidence of AEs and SAE is of concern and further studies are necessary to assess their relevance.
Url:
DOI: 10.1111/j.1399-3046.2007.00749.x
Affiliations:
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P." last="Ibá Ez">J. P. Ibá Ez</name><affiliation wicri:level="1"><country xml:lang="fr">Argentine</country><wicri:regionArea>Nephrology Unit, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” Buenos Aires</wicri:regionArea><wicri:noRegion>Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Monteverde, M L" sort="Monteverde, M L" uniqKey="Monteverde M" first="M. L." last="Monteverde">M. L. Monteverde</name><affiliation wicri:level="1"><country xml:lang="fr">Argentine</country><wicri:regionArea>Nephrology Unit, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” Buenos Aires</wicri:regionArea><wicri:noRegion>Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Diaz, M A" sort="Diaz, M A" uniqKey="Diaz M" first="M. A." last="Diaz">M. A. 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Garrahan” Buenos Aires</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Pediatric Transplantation</title><title level="j" type="alt">PEDIATRIC TRANSPLANTATION</title><idno type="ISSN">1397-3142</idno><idno type="eISSN">1399-3046</idno><imprint><biblScope unit="vol">11</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="777">777</biblScope><biblScope unit="page" to="780">780</biblScope><biblScope unit="page-count">4</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2007-11">2007-11</date></imprint><idno type="ISSN">1397-3142</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1397-3142</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Biopsy</term><term>Child</term><term>Cholesterol (blood)</term><term>Drug Therapy, Combination</term><term>Glomerular Filtration Rate (drug effects)</term><term>Humans</term><term>Immunosuppressive Agents (adverse effects)</term><term>Immunosuppressive Agents (therapeutic use)</term><term>Kidney Transplantation (immunology)</term><term>Kidney Transplantation (pathology)</term><term>Kidney Transplantation (physiology)</term><term>Platelet Count</term><term>Postoperative Complications (drug therapy)</term><term>Postoperative Complications (immunology)</term><term>Proteinuria (urine)</term><term>Retrospective Studies</term><term>Safety</term><term>Sirolimus (adverse effects)</term><term>Sirolimus (therapeutic use)</term><term>Transplantation, Homologous</term><term>Triglycerides (blood)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Association de médicaments</term><term>Biopsie</term><term>Cholestérol (sang)</term><term>Complications postopératoires (immunologie)</term><term>Complications postopératoires (traitement médicamenteux)</term><term>Enfant</term><term>Humains</term><term>Immunosuppresseurs (effets indésirables)</term><term>Immunosuppresseurs (usage thérapeutique)</term><term>Numération des plaquettes</term><term>Protéinurie (urine)</term><term>Sirolimus (effets indésirables)</term><term>Sirolimus (usage thérapeutique)</term><term>Sécurité</term><term>Taux de filtration glomérulaire ()</term><term>Transplantation homologue</term><term>Transplantation rénale (anatomopathologie)</term><term>Transplantation rénale (immunologie)</term><term>Transplantation rénale (physiologie)</term><term>Triglycéride (sang)</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Immunosuppressive Agents</term><term>Sirolimus</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Cholesterol</term><term>Triglycerides</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Transplantation rénale</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Glomerular Filtration Rate</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Immunosuppresseurs</term><term>Sirolimus</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Complications postopératoires</term><term>Transplantation rénale</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Kidney Transplantation</term><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Kidney Transplantation</term></keywords><keywords scheme="MESH" qualifier="physiologie" xml:lang="fr"><term>Transplantation rénale</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Kidney Transplantation</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Cholestérol</term><term>Triglycéride</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Immunosuppressive Agents</term><term>Sirolimus</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Complications postopératoires</term></keywords><keywords scheme="MESH" qualifier="urine" xml:lang="en"><term>Proteinuria</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Immunosuppresseurs</term><term>Protéinurie</term><term>Sirolimus</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Biopsy</term><term>Child</term><term>Drug Therapy, Combination</term><term>Humans</term><term>Platelet Count</term><term>Retrospective Studies</term><term>Safety</term><term>Transplantation, Homologous</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Association de médicaments</term><term>Biopsie</term><term>Enfant</term><term>Humains</term><term>Numération des plaquettes</term><term>Sécurité</term><term>Taux de filtration glomérulaire</term><term>Transplantation homologue</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract">Abstract: CAN is a common cause of late graft loss. Nephrotoxicity due to CNIs is known to contribute to CAN. We retrospectively evaluated the efficacy and safety of SRL in pediatric renal Tx recipients showing CAN in their allograft biopsy. Twenty‐one patients aged 10.4 ± 4.6 yr at Tx time receiving CNIs as primary immunosuppression were converted to SRL at 58.9 ± 49.1 months after Tx, due to progressive decline of renal function and biopsy proven CAN. Mean follow‐up after switch was 19.7 ± 9.5 months. All patients received CsA as part of the immunosuppressive regimen, at a mean dose 4.4 ± 1.2 mg/kg/day. Mean daily dose of SRL three month after conversion was 2.6 ± 0.8 mg/body surface area/day and the mean through levels where 6.9 ± 2.5 ng/mL. Graft biopsies showed Grade I CAN in 12 children and Grade II CAN in nine. After SRL introduction, there were neither acute rejection episodes nor graft losses. GFR improved at three months and was sustained thereafter only in children with Grade I CAN. Post‐Tx time at conversion was the only significant variable between patients who had Grade I CAN and Grade II CAN (33.6 ± 33.3 vs. 92.7 ± 47.5 months, p = 0.003). Nine patients had no AEs, six patients had nine SAE: five diarrhea, one herpes zoster, one pancreatic pseudo cyst, one pneumonia, and one Influenza A infection; 11 patients had 13 AEs: six oral aphthous ulcers, three urinary tract infections, two herpes simplex, one lymphedema, and one nephrotic proteinuria. Significant improvement of GFR occurred in Grade I CAN group at three months from conversion and was sustained during follow‐up. Those who had Grade II CAN experienced no change in GFR. The incidence of AEs and SAE is of concern and further studies are necessary to assess their relevance.</div></front></TEI><affiliations><list><country><li>Argentine</li></country></list><tree><country name="Argentine"><noRegion><name sortKey="Iba Ez, J P" sort="Iba Ez, J P" uniqKey="Iba Ez J" first="J. P." last="Ibá Ez">J. P. Ibá Ez</name></noRegion><name sortKey="Diaz, M A" sort="Diaz, M A" uniqKey="Diaz M" first="M. A." last="Diaz">M. A. Diaz</name><name sortKey="Goldberg, J" sort="Goldberg, J" uniqKey="Goldberg J" first="J." last="Goldberg">J. Goldberg</name><name sortKey="Monteverde, M L" sort="Monteverde, M L" uniqKey="Monteverde M" first="M. L." last="Monteverde">M. L. Monteverde</name><name sortKey="Turconi, A F" sort="Turconi, A F" uniqKey="Turconi A" first="A. F." last="Turconi">A. F. Turconi</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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