V. Papalois

Mycophenolic acid 12-h trough level monitoring in renal transplantation: association with acute rejection and toxicity.

Studies of renal transplantation utilizing trough plasma level monitoring of mycophenolic acid (MPA) have shown inconsistent associations with toxicity and rejection.

Steroid Sparing with Tacrolimus and Mycophenolate Mofetil in Renal Transplantation

Evidence suggests that steroid sparing in renal transplantation is associated with good outcomes, although there are limited data regarding steroid sparing in Tacrolimus and Mycophenolate Mofetil (MMF)‐based regimes. In this study we describe the use of these agents in 101 consecutive patients undergoing renal transplantation using only a 7‐day course of prednisolone.

Pediatric kidney transplantation: Historic hallmarks and a personal perspective

Abstract: Over the last five decades, pediatric kidney transplantation (Tx) has proved to be a viable therapeutic alternative for children with end‐stage renal disease. Patient and graft survival rates, as well as long‐term quality of life, have improved dramatically during this time, as a result of advances in surgical techniques, immunosuppression, and pre‐ and post‐operative care. The inspired, hard work of multi‐disciplinary clinical teams, combined with the determination and courage of the young patients and their families, have fueled the success of pediatric kidney Tx. It is with similar optimism and drive that we face the great challenges of the future, such as maximizing the donor pool and inducing tolerance.

Five-year results of kidney transplantation under tacrolimus-based regimes: the persisting significance of vascular rejection.

Background. Acute rejection has been the major risk factor for medium-term kidney graft loss because of chronic allograft nephropathy. We investigated whether the use of improved immunosuppression has altered the relationship between acute and chronic rejection by analyzing data from 245 renal transplant patients receiving Tacrolimus-based immunosuppression. Results. Five-year graft survival (censored for death with functioning graft) was 88.8% with no significant difference between living and cadaveric kidney transplants. The only significant predictor of medium-term graft loss was acute vascular rejection. Conclusion. Under Tacrolimus-based immunosuppression, the occurrence of acute interstitial rejection, even when occurring late, repeatedly, or with failure of graft function to return to baseline, was not associated with chronic allograft nephropathy or medium-term graft loss. Vascular rejection remains the major immunological obstacle to long-term transplant success. Five-year overall survival rates with a functioning graft of 80% with 90% graft survival censored for death with function seem to be realistic and achievable goals.