Late evolution of kidney transplants in elderly donors and recipients receiving initial immunosuppressant treatment with daclizumab, mycophenolate mofetil, and delayed introduction of tacrolimus

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Nefrourología, Hospital Universitario Virgen del Rocío, Sevilla, " "etiqueta" => "c" "identificador" => "affc" ] 2 => array:3 [ "entidad" => "Servicio Nefrología, HOSPITAL CARLOS HAYA, Malaga, Malaga, Spain, " "etiqueta" => "d" "identificador" => "affd" ] 3 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Regional Universitario Carlos Haya, Málaga, " "etiqueta" => "e" "identificador" => "affe" ] 4 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Puerta del Mar, Cádiz, " "etiqueta" => "f" "identificador" => "afff" ] 5 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona, " "etiqueta" => "g" "identificador" => "affg" ] 6 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitari Son Dureta, Palma de Mallorca, " "etiqueta" => "h" "identificador" => "affh" ] 7 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General de Alicante, Alicante, " "etiqueta" => "i" "identificador" => "affi" ] 8 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital La Fe Valencia, Valencia, Spain, " "etiqueta" => "j" "identificador" => "affj" ] 9 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitari La Fe, Valencia, " "etiqueta" => "k" "identificador" => "affk" ] 10 => array:3 [ "entidad" => "Servicio Nefrología, Hospital de Cruces, Baracaldo, Bil, Spain, " "etiqueta" => "l" "identificador" => "affl" ] 11 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario de Cruces, Barakaldo, Bizkaia, " "etiqueta" => "m" "identificador" => "affm" ] 12 => array:3 [ "entidad" => "Servicio Nefrología, Hospital Germans Trías i Pujol, Badalona, Barcelona, Spain, " "etiqueta" => "n" "identificador" => "affn" ] 13 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, " "etiqueta" => "o" "identificador" => "affo" ] 14 => array:3 [ "entidad" => "Servicio Nefrología, Hospital 12 de Octubre, Madrid, Madrid, Spain, " "etiqueta" => "p" "identificador" => "affp" ] 15 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, " "etiqueta" => "q" "identificador" => "affq" ] 16 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital de Santiago, Santiago de Compostela, A Coruña, " "etiqueta" => "r" "identificador" => "affr" ] 17 => array:3 [ "entidad" => "Servicio Nefrología, Hospital Marqués de Valdecilla, Santander, Santander, Spain, " "etiqueta" => "s" "identificador" => "affs" ] 18 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, " "etiqueta" => "t" "identificador" => "afft" ] 19 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Virgen de las Nieves, Granada, " "etiqueta" => "u" "identificador" => "affu" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución tardía del trasplante renal de donante y receptor añosos con una inmunosupresión inicial con daclizumab, mofetil-micofenolato e introducción retrasada de tacrolimus" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11024_16025_31545_en_t1a11024en.jpg" "Alto" => 764 "Ancho" => 1081 "Tamanyo" => 156545 ] ] "descripcion" => array:1 [ "en" => "Patient characteristics after one year" ] ] ] "textoCompleto" => "INTRODUCTION         The global increase in life expectancy and the expanded use of renal replacement programmes for chronic kidney disease have led to an increase in the mean age of patients treated.1 Kidney transplants (KT) are currently the treatment of choice for appropriate patients with established chronic kidney disease, since they improve patient survival and quality of life as compared to those who remain on dialysis, not only in young individuals, but also in the elderly population.2 Several studies have yielded excellent results performing transplants in elderly recipients, with patient and graft survival rates of 70% and 60%, respectively, after 5 years.3 These results have led to the growing acceptance of placing elderly patients on organ waiting lists.4The expansion of inclusion criteria for KT combined with a limited availability of donated organs has led to the use of cadaveric donors at higher ages, even although these kidneys are inferior.3,5 The structural and functional changes associated with advanced age (glomerulosclerosis, arteriolar hyalinosis, reduced functional kidney mass, and reduced glomerular filtration rate) can make these organs especially vulnerable to the aggressions produced in the ischaemia-reperfusion process, since tissue repair mechanisms are diminished in these cases. These factors increase the risk of delayed graft function and acute rejection5,6 and decrease the rate of graft survival. On the other hand, the primary cause of graft loss in elderly recipients is the death of patients with a functioning graft (approximately 50%, versus 15% in young recipients), which might imply that organs with a shorter expected functional life span would cover the needs of elderly recipients in terms of life expectancy.4,6 This is why kidneys donated by elderly donors are usually transplanted into elderly recipients.7The physiological alterations that occur with advanced age include changes in absorption, distribution, and metabolism, which affect the pharmacokinetics and pharmacodynamics of immunosuppressant drugs, increasing the frequency and severity of toxicity.8-10 Calcineurin inhibitors (CNI) can negatively affect the incidence and duration of delayed renal function, increasing the risk of acute nephrotoxicity by inducing oxidative stress.11,12 The prolonged use of CNI at normal doses contributes to decreased renal function and chronic allograft nephropathy, which is the primary cause of late graft loss. In addition, the use of these drugs can exacerbate many of the more important cardiovascular risk factors in these patients (hypertension, diabetes mellitus, and dyslipidaemia), and increases the risk of developing tumours.13,14The majority of studies researching the most appropriate immunosuppression therapy in elderly transplant recipients have thus been based on low or non-existent CNI regimens,14-16 and usually involve antibody-based induction, mycophenolate mofetil (MMF), and/or proliferation signal inhibitors (PSI).17In a previous study carried out by our group involving 133 KT with elderly donors and recipients, we observed good patient and graft survival rates (after 12 months, patient survival was 97.7%, graft survival was 96.1%, and graft survival adjusted for patient death was 98.5%), with good renal function and a low rate of secondary side effects. The treatment protocol involved daclizumab, MMF, and delayed introduction of low doses of tacrolimus (TC).18 In this study, 42.86% of patients suffered initial delayed graft function and 13.5% suffered acute rejection. In the present study, we have reviewed the long-term results from this same group of patients. PATIENTS AND METHOD The primary objective of our study was to analyse long-term patient survival. We also examined the evolution of renal function, the number of patients whose CNI and/or anti-metabolite regimens were modified, the safety profile associated with blood pressure and glucose and lipid metabolism, and the rate of neoplasia.We designed a nationwide observational, retrospective, multi-centre study of the evolution of patients who reached 1 year of follow-up from the group of 133 patients that started the initial study.18 The selection criteria for the original study were: age ≥50 years, panel reactive antibodies <25% in the previous 6 months, and recipients of a single kidney, coming from organ donors ≥55 years of age, with a cold ischaemia time <30 hours. In terms of sex distribution, 64% of donors and 60% of recipients were male. The mean age of the recipients was 61.3±6.2 years and the mean donor age was 64.4±5.3 years.Initial immunosuppressant treatment consisted of daclizumab in combination with MMF, TC, and steroids. Patients received two doses of daclizumab at 1.0mg/kg (maximum: 100mg): the first dose 6 hours before starting the transplant surgery (day 0 of the study), and the second dose on day 14. MMF was administered orally at 2g/day (1g/12 hours) until day 45 of the study, and was then adjusted based on the criteria of each centre. The initial dose of TC was 0.1mg/kg/day, and was started between the 5th and 7th day after transplantation, once renal function had stabilised (creatinine [Cr] less than 3.0mg/dl, or Cr clearance >30ml/min) and never after 7 days following the procedure. Dosage was adjusted in order to reach trough levels of 4-8ng/ml. As regards steroid treatment, methylprednisolone was administered at 500mg at the moment of surgery, and was then reduced in the following manner: day 1: 125mg intravenously every 24 hours; days 2-14: 20mg/24 hours; days 15-30: 15mg/24 hours; days 31-90: 5-10mg; and days 91-360: according to each hospital’s protocol. Prophylactic treatment was recommended against cytomegalovirus and Pneumocystis jiroveci, following the established protocol at each hospital.For the statistical analysis, we measured the following variables at the end of years 1-6 of the TR follow-up period: renal function (plasma Cr and glomerular filtration rate [MDRD]), standard laboratory measurements, post-transplant de novo diabetes (defined using the American Diabetes Association [ADA] criteria), neoplasia, biopsy-confirmed acute rejection, blood pressure, dyslipidaemia, type of immunosuppression (drugs, doses, and blood levels of CNI, reasons for drug withdrawal if any, and toxicity), concomitant drugs prescribed (anti-hypertensive agents, lipid-lowering drugs, oral anti-diabetic and/or insulin drugs, and erythropoietin), graft loss, and/or death and causes.One hundred and twenty-seven of the 133 patients included in the original study reached the first year with a functioning kidney transplant, and 122 of them were included in the present study and monitored in participating hospitals. Their general characteristics are described in the Table. We obtained information regarding patient evolution for all 122 cases, almost all of which were monitored for at least 5 years. At the time this study was completed, only 62 patients had reached six years of follow-up. STATISTICAL ANALYSES We used SPSS statistical software, version 11.0, for all descriptive and inferential statistical analyses. Organ and patient survival rates were calculated using Kaplan-Meier survival curves at 1, 2, 3, 4, 5, and 6 years following transplantation. All other variables were expressed as absolute and relative frequencies in the case of qualitative variables, and as mean, standard deviation, median, and interquartile range for quantitative variables. We also analysed changes in immunosuppressant regimens and the combination of immunosuppressants between the follow-up years using Pearson’s chi-square tests for qualitative variables. We established a significance level of P<.05. For all cases in which we compared different variables at two different moments in time (baseline vs 1 year post-transplantation) we used paired two-tailed t-tests. RESULTS Over the course of the study, the number of patients maintained within the follow-up programme was: 120 (end of 2nd year), 118 (end of 3rd), 113 (end of 4th), and 102 (end of 5th); only 62 patients were monitored for 6 years. The primary objective of the study, patient and organ survival (adjusted for patient death) 5 years after KT, resulted in 93.1% and 93.8%, respectively (determined from the survival results for all 122 cases starting at the time of the KT). A total of 10 deaths were reported over the course of the study. The most common causes of death were neoplasia (7 of 10 cases); specifically, 2 lymphoma, 2 brain tumours, 2 pulmonary adenocarcinomas, and 1 colon adenocarcinoma. The majority of cancers appeared between the 5th and 6th years following KT. The other causes of death were 2 acute myocardial infarctions (in the 2nd and 3rd years), and one gastrointestinal haemorrhage (in the 3rd year). The primary cause of graft loss was death with a functioning kidney, and all other failures were attributed to chronic allograft nephropathy (6 cases) or unknown cause (2 cases).The mean creatinine value increased from 1.60±0.50mg/dl in the first year to 1.63±0.70mg/dl at the end of the study (P<.05); mean MDRD score went from 46.28±15.64ml/min/1.73m2 to 45.69±15.44ml/min/1.73m2 (P<.001) (Figure 1). At the fifth year of follow-up, mean Cr was 1.61±0.60mg/dl (P=.068), and MDRD was 45.79±15.25ml/min/1.73m2 (P<.01). In the paired two-tailed t-test for repeated measures, renal function (measured by Cr or MDRD) decreased significantly over time (P<.001), although this was progressive and moderate in absolute terms. These comparisons do not take into account the effect of positive selection in terms of deaths (patients with better initial renal function tend to survive longer). Analysing patients that reached the 6th year of follow-up as a separate group, mean Cr went from 1.49±0.40mg/dl in the first year to 1.69±0.70mg/dl in the 6th year (P<.05); mean MDRD in this group went from 49.40±14.54ml/min/1.73m2 in the first year to 48.62±14.31ml/min/1.73m2 in the sixth year (P<.001). This change, which was quantitatively somewhat higher than in the overall group, is still not very clinically relevant.Only 2 cases of acute rejection were recorded after the first year of follow-up, both of which were associated with by T-cells and occurred during the second year, with IA and IIA histological classifications (Banff criteria) and a good response to steroid bolus treatment. The level of compliance with the initial immunosuppression scheme was very high, such that, after 5 years, 92% of patients continued treatment with TC and 80% continued with MMF (Figure 2). The most common cause of withdrawal of MMF was an attempt to reduce immunosuppression dosage, followed by gastrointestinal toxicity and haematological toxicity (leucopoenia). The mean TC dose was progressively reduced from 4.09mg/day at the end of the first year to 2.95mg/day at the end of the fifth year, with mean trough blood levels of 7.35ng/ml and 6.2ng/ml, respectively (Figure 3). The mean dose of MMF remained fairly stable from the second year onwards, and was 997mg/day at the fifth year. Steroids were suspended in the second year in 38% of patients, and in the sixth year in 48%. In a small group that constituted 4% of the total at the end of the study, a PSI was also administered. In another small group of 2.4% of patients, azathioprine was started, in the second year in almost all cases, and was maintained until the end of the study (Figure 2).Throughout the follow-up period, concomitant medication was increased in order to provide better control of the most frequently risk factors in these patients. Anti-hypertensive drugs, which were used by 76% of patients at the end of the first year, were employed in 92.9% of patients at the end of the fifth year; statin use rose from 32.6% to 63% over this same interval, erythropoietin use rose from 8.7% to 18.4%, and oral anti-diabetic and/or insulin drug use rose from 9.8% to 15.7%; all of these differences in drug use were statistically significant. A total of 19 cardiovascular events occurred in 12 patients over the course of the study: 3 acute myocardial infarctions (2 of which caused patient death), 2 strokes, and 14 peripheral arteriopathies. At least one type of cancer was observed in 14.3% of patients (and more than 1 was observed in 4%). Skin cancer was the most common form of neoplasia (50%), while post-transplant lymphoproliferative syndrome accounted for 11% and other solid tumours constituted 39%. DISCUSSION The waiting lists for KT programmes show a growing proportion of older patients. At the same time, the mean donor age has increased in recent years, with a consequently higher rate of associated cardiovascular pathology and functional deterioration of the transplant. This has led to an increasing practice of transplanting organs from elderly donors and those with expanded criteria into elderly recipients. The validity of assigning these organs to elderly recipients has been shown in several studies.19,20Some authors have suggested that the rate of rejection in elderly recipients is lower due to the less active or quiescent immune system in these patients. While the results extracted from large studies of the United Network for Organ Sharing (UNOS) appear to confirm this hypothesis, other authors examining more recent patient groups have not observed a large difference in the rate of acute rejection between young and elderly recipients.21,22 On the other hand, the lower functional reserve inherent to the decreased nephron mass in elderly donors, as well as the reduced capacity for regeneration of the tissues after rejection, makes the case for a more negative impact on graft survival, compared young recipients.23There is a higher rate of associated comorbidities in elderly patients, such as diverticulosis, urinary tract anomalies, cardiovascular pathology, and diabetes, among others, as well as a higher incidence of cancer.21,24 As such, the risk of suffering severe infections and tumour-related diseases following immunosuppression therapy is higher, and the rate of mortality due to these processes is higher than in young recipients.25 These factors require an adapted immunosuppression regimen for the specific characteristics of the donor and the recipient. This protocol must be sufficiently effective to avoid rejection (because of the lower graft survival rate and the higher risk of infection associated with treatment) but must not lead to over-immunosuppression, which could increase the number of infections and tumours in more susceptible recipients. However, we also lack prospective multi-centre studies with a randomised design that have analysed this issue in large cohorts of patients. In addition, elderly recipients are frequently excluded from trials of new immunosuppressant treatments due to the possibility of secondary side effects associated with altered pharmacokinetics that might impede the interpretation of study results. The need for reducing the nephrotoxicity associated with CNI, whose effects may be exacerbated by ischaemia-reperfusion damage, thus preserving the largest nephron mass possible, makes prescriptions that minimise or fully eliminate CNI of special interest in this group of recipients.21,26Induction with anti-lymphocyte antibodies or anti-IL-2 is very useful for reducing the prevalence of acute rejection. Given the lower risk of severe infection or cancer associated with their use, IL-2 antibody receptor antagonists may be preferable over thymoglobulin in recipients with a low immunological risk: the rate of acute rejection does not vary by much, but this does provide a better safety profile.26,27Arbogast et al15 treated patients without CNI using MMF doses adjusted to maintain trough levels of 2-6µg/ml and induction with mono-polyclonal antibodies in recipients and donors of a similar age to our study. They observed a 5-year survival rate of 87.69% and a graft survival rate of 69.8% (adjusted for patient death and non-immunological causes: 86.57%), although this was lower than in our study and involved a much higher rate of acute rejection (23.6%).15 Later publications from this same group observed similar results with even higher rejection rates, which led to 46.3% of patients receiving and added CNI in their treatment regimens. Despite the good survival rates observed in comparison to other studies involving treatment with CNI, the high rates of rejection and cytomegalovirus infection (requiring a reduction of MMF and the introduction of CNI or PSI) place doubts on the validity of immunosuppression regimens without CNI.28,29In a controlled study (SENIOR), no advantages were observed with a delayed introduction of TC (after 7 days, after complete withdrawal of steroid treatment) as compared to immediate use, in terms of frequency, duration of functional delay, or renal function after 6 months.30 The mean duration of functional delay in the case of donors older than 60 years with a delayed introduction of TC was 19 days, much higher than in our study (7 days, with a median of 4 days); the frequency of early acute rejection was also much higher in this study than in ours. Previous studies also failed to demonstrate an advantage of delayed TC introduction with depletive antibody31 or cyclosporine32 induction in terms of the incidence of delayed function. However, initial CNI doses and levels in these studies were standard and higher than in ours. In all likelihood, the appearance of delayed graft function requiring dialysis is mediated by factors that come into play prior to immunosuppression therapy (donor age, vasculopathy, cause of death, conditions surrounding donor suffering, cold ischaemia, etc.) and cannot be modified by a delayed introduction of CNI. In contrast, lower doses and blood levels (with or without delayed introduction) may be more useful for shortening its duration. The results of the Symphony study33 attest to the efficacy and safety of an immunosuppressant regimen with low initial doses of TC.In a study involving 72 patients older than 60 years, Solà et al. assessed the results of a treatment regimen based on steroids, MMF, and TC, with the addition of thymoglobulin and a delayed start of TC (at 1mg/kg/day, similar to our study) upon delayed graft function (which occurred in 48.6% of cases). This led to a rapid resolution of delayed graft function cases (mean 3.9 days) and a 12.5% rejection rate. Patient survival after 3 years was 90%, and graft survival was 87% (97% after adjusting for patient death).34In our experience, the use of this treatment regimen produces very satisfactory results in terms of mid-term patient and organ survival, with even better rates than those observed in other studies.29 As in previous studies, the primary cause of graft loss was patient death, primarily due to cancer. None of the deaths in our study were due to infections. The rate of acute rejection after the first year was low, showing a sufficient level of immunosuppression. Deterioration of renal function was very mild, with excellent Cr and GFR rates at the end of the fifth year. We also observed a very high level of compliance with the prescribed immunosuppression protocol, as most patients remained on the planned MMF/TC regimen. There was a clear tendency for the maintenance of trough TC values at the upper limit of the predicted range during the first years of follow-up, although these values became more moderate over the course of the study. This is probably due to the minimal treatment applied when using a conservative approach, as observed in large studies such as the Symphony study.33The design of our study had some methodological weaknesses, such as the retrospective nature of the study and the lack of a control group treated with an immunosuppression regimen without delayed introduction and minimal doses of CNI, as we explained in our previous publication. Prospective studies without these limitations and involving a larger number of patients would be needed to establish how appropriate this type of immunosuppression therapy would be for the transplantation of organs from elderly or expanded criteria donors into elderly recipients.In conclusion, we believe that the treatment regimen used in our study, involving induction with two doses of daclizumab, along with MMF and a late introduction of TC at low doses, is useful and appropriate for elderly donor-recipient pairs, as shown by the good long-term survival results and the maintenance of optimal renal function and acceptable safety profiles. Conflicts of interest The authors affirm that they have no conflicts of interest related to the content of this article.<a href="grande/11024_16025_31545_en_t1a11024en.jpg" class="elsevierStyleCrossRefs"><img src="11024_16025_31545_en_t1a11024en.jpg" alt="Patient characteristics after one year"></img></a>Table 1. Patient characteristics after one year<a href="grande/11024_16025_31546_en_f1a11024en.jpg" class="elsevierStyleCrossRefs"><img src="11024_16025_31546_en_f1a11024en.jpg" alt="Evolution of renal function"></img></a>Figure 1. Evolution of renal function<a href="grande/11024_16025_31547_en_f2a11024en.jpg" class="elsevierStyleCrossRefs"><img src="11024_16025_31547_en_f2a11024en.jpg" alt="Use of immunosuppressants (% of all patients) in each year following transplantation"></img></a>Figure 2. Use of immunosuppressants (% of all patients) in each year following transplantation<a href="grande/11024_16025_31548_en_f3a11024en.jpg" class="elsevierStyleCrossRefs"><img src="11024_16025_31548_en_f3a11024en.jpg" alt="Evolution of tacrolimus trough blood levels throughout the study"></img></a>Figure 3. Evolution of tacrolimus trough blood levels throughout the study" "pdfFichero" => "P1-E541-S3617-A11024-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437913" "palabras" => array:1 [ 0 => "Daclizumab" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437915" "palabras" => array:1 [ 0 => "Tacrolimus" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437917" "palabras" => array:1 [ 0 => "Mofetil-micofenolato" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437919" "palabras" => array:1 [ 0 => "Trasplante renal" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437921" "palabras" => array:1 [ 0 => "Donante añoso" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437923" "palabras" => array:1 [ 0 => "Receptor añoso" ] ] ] "en" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437914" "palabras" => array:1 [ 0 => "Daclizumab" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437916" "palabras" => array:1 [ 0 => "Tacrolimus" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437918" "palabras" => array:1 [ 0 => "Mycophenolate mofetil" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437920" "palabras" => array:1 [ 0 => "Kidney transplant" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437922" "palabras" => array:1 [ 0 => "Elderly donor" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437924" "palabras" => array:1 [ 0 => "Elderly recipient" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Antecedentes: El trasplante de órganos de donantes añosos en receptores de edad avanzada se ha incrementado en los últimos años. Esta situación plantea problemas específicos tanto en el órgano como en el receptor, y la pauta de inmunosupresión debe ser adaptada a ellos. Un estudio previo mostró buenos resultados iniciales en el trasplante renal de donante y receptor añosos (medias de edad: 64,4 y 61,3 años) con una inmunosupresión inicial de daclizumab, mofetil-micofenolato e introducción retrasada de tacrolimus a dosis bajas. En el presente estudio revisamos los resultados a largo plazo en ese mismo grupo de pacientes. Métodos: Estudio observacional, retrospectivo y multicéntrico a nivel nacional de la supervivencia y función renal de 126 pacientes incluidos en el estudio inicial (sobre 127 que alcanzaron el primer año con riñón funcionante, 123 tratados según protocolo). Obtuvimos datos del segundo al sexto año de: 120, 118, 113, 102 y 62 pacientes. Secundariamente se analizó la evolución de la función renal, aspectos clínicos relevantes y el perfil de seguridad. Resultados: A los 5 años, la mayoría de los casos continuaban con el esquema inmunosupresor inicial: 92% tacrolimus y 80% mofetil-micofenolato; 48% habían abandonado los esteroides y se introdujo un inhibidor de la señal de proliferación en 3%. La supervivencia del paciente y el órgano (censurada para muerte) a los 5 años resultó de 93,1 y 93,8%, respectivamente. La principal causa de muerte fue la neoplasia (en 7 de los 10 casos) y, de pérdida de injerto, la muerte con riñón funcionante. Las otras causas de muerte fueron 2 infartos agudos de miocardio y una hemorragia digestiva. La función renal se redujo significativa pero moderadamente a lo largo del tiempo (p < 0,001): la creatinina media en el conjunto de pacientes pasó de 1,60 ± 0,50 mg/dl al primer año a 1,63 ± 0,70 al cierre del estudio (p < 0,05); MDRD de 46,28 ± 15,64 ml/min al primer año a 45,69 ± 15,44 al cierre del estudio (p < 0,01). Sólo se registraron 2 rechazos agudos después del primer año. Se registraron 19 eventos cardiovasculares en 12 pacientes. Conclusiones: La pauta utilizada en nuestro estudio resulta útil y adecuada para parejas donante-receptor de mayor edad, como demuestran los buenos resultados en supervivencia a largo plazo, y el mantenimiento de una óptima función renal y un perfil de seguridad aceptables.   " ] "en" => array:1 [ "resumen" => "Background: Organ transplants in elderly recipients have increased over the past few years. This situation poses specific problems both in terms of organs and recipients; therefore, immunosuppressant regimens must be adapted accordingly. A previous study demonstrated good initial results in kidney transplant cases in which older donors and recipients (average ages of 64.4 years and 61.3 years) had received initial immunosuppressant therapy with daclizumab and mycophenolate mofetil as well as delayed introduction of reduced-dose tacrolimus. In this study we reviewed the long-term results in the same group of patients. Methods: An observational, retrospective multi-centre study carried out at a national level to determine survival rates and renal function in 126 patients included in the initial study (127 patients who survived the first year with a functioning graft, 123 treated according to protocol). We gathered data from the 2nd to the 6th year for 120, 118, 113, 102 and 62 patients, respectively. The evolution of renal function, relevant clinical data, and safety profiles were also analysed. Results: After five years, most patients continued with the initial immunosuppressant regimen: 92% tacrolimus and 80% mycophenolate mofetil; 48% had abandoned steroids and proliferation signal inhibitors had been introduced in 3%. Patient and graft survival (adjusted for patient death) after five years was 93.1% and 93.8%, respectively. The main cause of death was neoplasia (in 7 out of 10 cases) whilst graft loss was mainly due to death with a functioning graft. The other causes of death were 2 acute myocardial infarctions and a gastrointestinal haemorrhage. Renal function was moderately but significantly reduced with the passing of time (P<.001): average creatinine levels in the overall group of patients rose from 1.60±0.50mg/dl after the 1st year to 1.63±0.70mg/dl at the end of study. MDRD dropped from 46.28±15.64ml/min after the 1st year to 45.69±15.44ml/min at the end of study (P<.01). Only two acute rejections were observed after the 1st year. There were 19 cardiovascular events registered in 12 patients. Conclusions: The regimen used in our study was useful and appropriate for elderly donor-recipient pairs as demonstrated by the good long-term survival results, continued optimum renal function, and acceptable safety profile. " ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11024_16025_31545_en_t1a11024en.jpg" "Alto" => 764 "Ancho" => 1081 "Tamanyo" => 156545 ] ] "descripcion" => array:1 [ "en" => "Patient characteristics after one year" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11024_16025_31546_en_f1a11024en.jpg" "Alto" => 1109 "Ancho" => 2107 "Tamanyo" => 183162 ] ] "descripcion" => array:1 [ "en" => "Evolution of renal function" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11024_16025_31547_en_f2a11024en.jpg" "Alto" => 1209 "Ancho" => 2107 "Tamanyo" => 182109 ] ] "descripcion" => array:1 [ "en" => "Use of immunosuppressants (% of all patients) in each year following transplantation" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11024_16025_31548_en_f3a11024en.jpg" "Alto" => 1122 "Ancho" => 2107 "Tamanyo" => 140877 ] ] "descripcion" => array:1 [ "en" => "Evolution of tacrolimus trough blood levels throughout the study" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Danovitch GM, Cohen DJ, Weir MR,\u{A0}Stock PG,\u{A0}Bennett WM,\u{A0}Christensen LL,\u{A0}et al. Current status of kidney and pancreas transplantation in the United States, 1994¿2003. Am J Transplant 2005;5:904-15." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wolfe RA, Ashby VB, Milford EL, Ojo AO,\u{A0}Ettenger RE,\u{A0}Agodoa LY,\u{A0}et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10580071" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fijter JW.The impact of Age on rejection in kidney transplantation. Review article. Drugs aging 2005;22(5)." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Doyle SE, Matas AJ, Gillingham K, Rosenberg ME. Predicting clinical outcome in the elderly renal transplant recipient. Kidney Int 2000;57:2144-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10792636" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Reutzel-Selke A,\u{A0}Filatenkov A,\u{A0}Jurisch A,\u{A0}Denecke C,\u{A0}Martins PN,\u{A0}Pascher A,\u{A0}et al. Grafts from elderly donors elicit a stronger immune response in the early period post transplantation: a study in a rat model. Transplant Proc 2005;37(1):382-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15808652" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Oniscu GC, Brown H, Forsythe JL. How old is old for transplantation? Am J Transplant 2004;4:2067-74. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15575911" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Danovitch G, Savransky E. Challenges in the counseling and management of older kidney transplant candidates. Am J Kidney Dis 2006;47(4 Suppl 2):S86-97. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16567243" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Meier-Kriesche HU, Kaplan B. Immunosuppression in elderly renal transplant recipients: Are current regimens too aggressive? Drugs Aging 2001;18:751-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11735622" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bernardo JF, McCauley J. Drug therapy in transplant recipients: special considerations in the elderly with comorbid conditions. Drugs Aging 2004;21:323-48. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15040759" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Zeeh J, Platt D. The aging liver: structural and functional changes and their consequences for drug treatment in old age. Gerontology 2002;48:121-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11961363" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Meier-Kriesche HU, Ojo AO, Cibrik DM,\u{A0}Hanson JA,\u{A0}Leichtman AB,\u{A0}Magee JC,\u{A0}et al. Relationship of recipient age and development of chronic allograft failure. Transplantation 2000;70:306-10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10933154" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Olyaei AJ, De Mattos AM, Bennett WM. Nephrotoxicity of immunosuppressive drugs: new insight and preventive strategies. Curr Opin Crit Care 2001;7 (6):384-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11805539" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Grinyo JM, Cruzado JM. Steroid or calcineurin inhibitor-sparing immunosuppressive protocols. Contrib Nephrol 2005;146:30-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15567918" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lo A. Strategies to prevent chronic allograft nephropathy in kidney transplantation: focus on calcineurin inhibitors. Prog Transplant 2004;14(2):157-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15264460" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Arbogast H, Huckelheim H, Schneeberger H,\u{A0}Illner WD,\u{A0}Tarabichi A,\u{A0}Fertmann J,\u{A0}et al. A calcineurin antagonist-free induction/maintenance strategy for immunosuppression in elderly recipients of renal allografts from elderly cadaver donors: Long-term results from a prospective single centre trial. Clin Transplant 2005;19:309. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15877790" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Emparan C, Wolters H, Laukotter M, Senninger N. Long-term results of calcineurin-free protocols with basiliximab induction in ¿old-toold¿ programs. Transplant Proc 2004;36:2646-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15621113" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kuypers DR. Benefit-risk assessment of sirolimus in renal transplantation. Drug Saf 2005;28(2):153-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15691225" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gentil MA, Osuna A, Capdevilla L, Canterell C, Pereira P, Mazuecos A, et al. Daclizumab en combinación con micofenolato mofetil e introducción tardía de tacrolimus a dosis bajas, como opción terapéutica en la pareja donante-receptor añoso en trasplante renal. Nefrologia 2008;28(3):287-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18590495" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Smits JM, Persijn GG, van Houwelingen HC, Claas FH, Frei U. Evaluation of the Eurotransplant Senior Program. The results of the first year. Am J Transplant 2002;2:664-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12201369" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Frei U, Noeldeke J, Machold-Fabrizzi V, Arbogast H,\u{A0}Margreiter R,\u{A0}Fricke L,\u{A0}et al. Prospective age-matching\u{A0} in elderly kidney transplant recipients ¿A 5-year analysis of the Eurotransplant Senior Program. Am J Transplant 2008;8:50-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17973969" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Meier-Kriesche HU, Ojo A, Hanson J, Cibrik D,\u{A0}Lake K,\u{A0}Agodoa LY,\u{A0}et al. Increased immunosuppressive vulnerability in elderly renal transplant recipients. Transplantation 2000;69:885-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10755545" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Palomar R, Ruiz JC, Zubimendi JA, Cotorruelo JG,\u{A0}de Francisco AL,\u{A0}Rodrigo E,\u{A0}et al. Acute rejection in the elderly recipient: Influence of age in the outcome of kidney transplantation. Int Urol Nephrol 2002;33:145-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12090322" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Meier-Kriesche HU, Srinivas TR, Kaplan B. Interaction between acute rejection and recipient age on long-term renal allograft survival. Transplant Proc 2001;33:3425-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11750467" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Trouillhet I, Benito N, Cervera C, Rivas P, Cofán F, Almela M, et al. Influence of age in renal transplant infections: cases and controls study. Transplantation 2005;80:989-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16249750" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Danovitch GM,\u{A0}Gill J,\u{A0}Bunnapradist S. Immunosuppression of the elderly kidney transplant recipient. Transplantation 2007;84(3):285-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17700150" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mourad G, Rostaing L, Legendre C, Garrigue V,\u{A0}Thervet E,\u{A0}Durand Dl. Sequential protocols using basiliximab versus antithymocyte globulins in renal-transplant patients receiving mycophenolate mofetil and steroids. Transplantation 2004;78:584-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15446319" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lebranchu Y, Bridoux F, Buchler M, Le Meur Y,\u{A0}Etienne I,\u{A0}Toupance O,\u{A0}et al. Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF-containing triple therapy. Am J Transplant 2002;2:48-56. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12095056" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Guba M, Rentsch M, Wimmer CD, Uemueksuez A,\u{A0}Illner WD,\u{A0}Schönermarck U,\u{A0}et al. Calcineurin-inhibitor avoidance in elderly renal allograft recipients using ATG and basiliximab combined with mycophenolate mofetil. Transpl Int 2008;21(7):637-45. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18282242" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pascual J,\u{A0}Zamora J,\u{A0}Pirsch JD. A systematic review of kidney transplantation from expanded criteria donors. Am J Kidney Dis 2008;52(3):553-86.\u{A0} <a href="http://www.ncbi.nlm.nih.gov/pubmed/18725015" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Andrés A,\u{A0}Budde K,\u{A0}Clavien PA, Becker T, Kessler M, Pisarski P, et al. A randomized trial comparing renal function in older kidney transplant patients following delayed versus immediate tacrolimus administration. Transplantation 2009;88(9):1101-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19898206" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mourad G, Garriague V, Squifflet JP, Besse T, Berthoux F, Alamartine E, et al. Induction vs. Noninduction\u{A0} in renal transplant recipients with tacrolimus-based immunosuppression. Transplantation 2001;72:1050-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11579299" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kamar N, Garrigue V, Karras A, Mourad G, Lefrançois N, Charpentier E, et al. Impact of early or delayed cyclosporin on delayed graft function in renal transplant recipients: A randomized, multicenter study. Am J Transplant 2006;6:1042-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16611342" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ekberg H, Tedesco-Silva H, Demirbas A, Vitko S, Nashan B, Gurkan A, et al.; ELITE-Symphony Study. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med 2007;357(25):2562-75. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18094377" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Solà R, Guirado L, Díaz JM, Facundo C, Gich I, Chuy E, et al. Tacrolimus/mycophenolate mofetil-based immunosuppression in aged kidney transplant. A prospective study. Int Immunopharmacol 2005;5(1):129-31. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15589471" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000004/v0_201502091610/X2013251412001634/v0_201502091610/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000004/v0_201502091610/X2013251412001634/v0_201502091610/en/P1-E541-S3617-A11024-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001634?idApp=UINPBA000064"]

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Evolución tardía del trasplante renal de donante y receptor añosos con una inmunosupresión inicial con daclizumab, mofetil-micofenolato e introducción retrasada de tacrolimus

Grupo de Estudio Español del Trasplante Renal de Donante Añoso., Grupo de Estudio Español del Trasplante Renal de Donante Añoso, Francisco Manuel González Roncerob, Francisco M. González-Ronceroc, Miguel Angel Gentil Govantesb, Miguel Á. Gentil-Govantesc, Miguel GONZALEZ MOLINAd, Miguel González-Molinae, Manuel Riverof, Carmen Cantarellg, Antonio Alarcónh, Antonio Francoi, Jaime Sánchez Plumedj, Jaime Sánchez-Plumedk, Idelfonso Lampreabel, Ildefonso Lampreabem, Ricardo Lauzurrican, Ricardo Lauzuricao, Esther Gonzalezp, Esther Gonzálezq..., Rafael Romeror, Juan Carlos Ruiz San Milláns, Juan C. Ruiz-San Millánt, Antonio OsunauVer más

b U.G.C Nefrourología, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla, Spain,

c U.G.C. Nefrourología, Hospital Universitario Virgen del Rocío, Sevilla,

d Servicio Nefrología, HOSPITAL CARLOS HAYA, Malaga, Malaga, Spain,

e Servicio de Nefrología, Hospital Regional Universitario Carlos Haya, Málaga,

f Servicio de Nefrología, Hospital Puerta del Mar, Cádiz,

g Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona,

h Servicio de Nefrología, Hospital Universitari Son Dureta, Palma de Mallorca,

i Servicio de Nefrología, Hospital General de Alicante, Alicante,

j Servicio de Nefrología, Hospital La Fe Valencia, Valencia, Spain,

k Servicio de Nefrología, Hospital Universitari La Fe, Valencia,

l Servicio Nefrología, Hospital de Cruces, Baracaldo, Bil, Spain,

m Servicio de Nefrología, Hospital Universitario de Cruces, Barakaldo, Bizkaia,

n Servicio Nefrología, Hospital Germans Trías i Pujol, Badalona, Barcelona, Spain,

o Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona,

p Servicio Nefrología, Hospital 12 de Octubre, Madrid, Madrid, Spain,

q Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid,

r Servicio de Nefrología, Hospital de Santiago, Santiago de Compostela, A Coruña,

s Servicio Nefrología, Hospital Marqués de Valdecilla, Santander, Santander, Spain,

t Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander,

u Servicio de Nefrología, Hospital Universitario Virgen de las Nieves, Granada,

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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION&#160;&#160;&#160;&#160;&#160;&#160;&#160; </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The global increase in life expectancy and the expanded use of renal replacement programmes for chronic kidney disease have led to an increase in the mean age of patients treated&#46;<span class="elsevierStyleSup">1</span> Kidney transplants &#40;KT&#41; are currently the treatment of choice for appropriate patients with established chronic kidney disease&#44; since they improve patient survival and quality of life as compared to those who remain on dialysis&#44; not only in young individuals&#44; but also in the elderly population&#46;<span class="elsevierStyleSup">2</span> Several studies have yielded excellent results performing transplants in elderly recipients&#44; with patient and graft survival rates of 70&#37; and 60&#37;&#44; respectively&#44; after 5 years&#46;<span class="elsevierStyleSup">3</span> These results have led to the growing acceptance of placing elderly patients on organ waiting lists&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">The expansion of inclusion criteria for KT combined with a limited availability of donated organs has led to the use of cadaveric donors at higher ages&#44; even although these kidneys are inferior&#46;<span class="elsevierStyleSup">3&#44;5</span> The structural and functional changes associated with advanced age &#40;glomerulosclerosis&#44; arteriolar hyalinosis&#44; reduced functional kidney mass&#44; and reduced glomerular filtration rate&#41; can make these organs especially vulnerable to the aggressions produced in the ischaemia-reperfusion process&#44; since tissue repair mechanisms are diminished in these cases&#46; These factors increase the risk of delayed graft function and acute rejection<span class="elsevierStyleSup">5&#44;6</span> and decrease the rate of graft survival&#46; On the other hand&#44; the primary cause of graft loss in elderly recipients is the death of patients with a functioning graft &#40;approximately 50&#37;&#44; versus 15&#37; in young recipients&#41;&#44; which might imply that organs with a shorter expected functional life span would cover the needs of elderly recipients in terms of life expectancy&#46;<span class="elsevierStyleSup">4&#44;6</span> This is why kidneys donated by elderly donors are usually transplanted into elderly recipients&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">The physiological alterations that occur with advanced age include changes in absorption&#44; distribution&#44; and metabolism&#44; which affect the pharmacokinetics and pharmacodynamics of immunosuppressant drugs&#44; increasing the frequency and severity of toxicity&#46;<span class="elsevierStyleSup">8-10</span> Calcineurin inhibitors &#40;CNI&#41; can negatively affect the incidence and duration of delayed renal function&#44; increasing the risk of acute nephrotoxicity by inducing oxidative stress&#46;<span class="elsevierStyleSup">11&#44;12</span> The prolonged use of CNI at normal doses contributes to decreased renal function and chronic allograft nephropathy&#44; which is the primary cause of late graft loss&#46; In addition&#44; the use of these drugs can exacerbate many of the more important cardiovascular risk factors in these patients &#40;hypertension&#44; diabetes mellitus&#44; and dyslipidaemia&#41;&#44; and increases the risk of developing tumours&#46;<span class="elsevierStyleSup">13&#44;14</span></p><p class="elsevierStylePara">The majority of studies researching the most appropriate immunosuppression therapy in elderly transplant recipients have thus been based on low or non-existent CNI regimens&#44;<span class="elsevierStyleSup">14-16</span> and usually involve antibody-based induction&#44; mycophenolate mofetil &#40;MMF&#41;&#44; and&#47;or proliferation signal inhibitors &#40;PSI&#41;&#46;<span class="elsevierStyleSup">17</span></p><p class="elsevierStylePara">In a previous study carried out by our group involving 133 KT with elderly donors and recipients&#44; we observed good patient and graft survival rates &#40;after 12 months&#44; patient survival was 97&#46;7&#37;&#44; graft survival was 96&#46;1&#37;&#44; and graft survival adjusted for patient death was 98&#46;5&#37;&#41;&#44; with good renal function and a low rate of secondary side effects&#46; The treatment protocol involved daclizumab&#44; MMF&#44; and delayed introduction of low doses of tacrolimus &#40;TC&#41;&#46;<span class="elsevierStyleSup">18</span> In this study&#44; 42&#46;86&#37; of patients suffered initial delayed graft function and 13&#46;5&#37; suffered acute rejection&#46; In the present study&#44; we have reviewed the long-term results from this same group of patients&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The primary objective of our study was to analyse long-term patient survival&#46; We also examined the evolution of renal function&#44; the number of patients whose CNI and&#47;or anti-metabolite regimens were modified&#44; the safety profile associated with blood pressure and glucose and lipid metabolism&#44; and the rate of neoplasia&#46;</p><p class="elsevierStylePara">We designed a nationwide observational&#44; retrospective&#44; multi-centre study of the evolution of patients who reached 1 year of follow-up from the group of 133 patients that started the initial study&#46;<span class="elsevierStyleSup">18</span> The selection criteria for the original study were&#58; age &#8805;50 years&#44; panel reactive antibodies &#60;25&#37; in the previous 6 months&#44; and recipients of a single kidney&#44; coming from organ donors &#8805;55 years of age&#44; with a cold ischaemia time &#60;30 hours&#46; In terms of sex distribution&#44; 64&#37; of donors and 60&#37; of recipients were male&#46; The mean age of the recipients was 61&#46;3&#177;6&#46;2 years and the mean donor age was 64&#46;4&#177;5&#46;3 years&#46;</p><p class="elsevierStylePara">Initial immunosuppressant treatment consisted of daclizumab in combination with MMF&#44; TC&#44; and steroids&#46; Patients received two doses of daclizumab at 1&#46;0mg&#47;kg &#40;maximum&#58; 100mg&#41;&#58; the first dose 6 hours before starting the transplant surgery &#40;day 0 of the study&#41;&#44; and the second dose on day 14&#46; MMF was administered orally at 2g&#47;day &#40;1g&#47;12 hours&#41; until day 45 of the study&#44; and was then adjusted based on the criteria of each centre&#46; The initial dose of TC was 0&#46;1mg&#47;kg&#47;day&#44; and was started between the 5<span class="elsevierStyleSup">th</span> and 7<span class="elsevierStyleSup">th</span> day after transplantation&#44; once renal function had stabilised &#40;creatinine &#91;Cr&#93; less than 3&#46;0mg&#47;dl&#44; or Cr clearance &#62;30ml&#47;min&#41; and never after 7 days following the procedure&#46; Dosage was adjusted in order to reach trough levels of 4-8ng&#47;ml&#46; As regards steroid treatment&#44; methylprednisolone was administered at 500mg at the moment of surgery&#44; and was then reduced in the following manner&#58; day 1&#58; 125mg intravenously every 24 hours&#59; days 2-14&#58; 20mg&#47;24 hours&#59; days 15-30&#58; 15mg&#47;24 hours&#59; days 31-90&#58; 5-10mg&#59; and days 91-360&#58; according to each hospital&#8217;s protocol&#46; Prophylactic treatment was recommended against cytomegalovirus and <span class="elsevierStyleItalic">Pneumocystis jiroveci</span><span class="elsevierStyleItalic">&#44; following the established protocol at each hospital&#46;</span></p><p class="elsevierStylePara">For the statistical analysis&#44; we measured the following variables at the end of years 1-6 of the TR follow-up period&#58; renal function &#40;plasma Cr and glomerular filtration rate &#91;MDRD&#93;&#41;&#44; standard laboratory measurements&#44; post-transplant <span class="elsevierStyleItalic">de novo</span> diabetes &#40;defined using the American Diabetes Association &#91;ADA&#93; criteria&#41;&#44; neoplasia&#44; biopsy-confirmed acute rejection&#44; blood pressure&#44; dyslipidaemia&#44; type of immunosuppression &#40;drugs&#44; doses&#44; and blood levels of CNI&#44; reasons for drug withdrawal if any&#44; and toxicity&#41;&#44; concomitant drugs prescribed &#40;anti-hypertensive agents&#44; lipid-lowering drugs&#44; oral anti-diabetic and&#47;or insulin drugs&#44; and erythropoietin&#41;&#44; graft loss&#44; and&#47;or death and causes&#46;</p><p class="elsevierStylePara">One hundred and twenty-seven of the 133 patients included in the original study reached the first year with a functioning kidney transplant&#44; and 122 of them were included in the present study and monitored in participating hospitals&#46; Their general characteristics are described in the Table&#46; We obtained information regarding patient evolution for all 122 cases&#44; almost all of which were monitored for at least 5 years&#46; At the time this study was completed&#44; only 62 patients had reached six years of follow-up&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">STATISTICAL ANALYSES</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">We used SPSS statistical software&#44; version 11&#46;0&#44; for all descriptive and inferential statistical analyses&#46; Organ and patient survival rates were calculated using Kaplan-Meier survival curves at 1&#44; 2&#44; 3&#44; 4&#44; 5&#44; and 6 years following transplantation&#46; All other variables were expressed as absolute and relative frequencies in the case of qualitative variables&#44; and as mean&#44; standard deviation&#44; median&#44; and interquartile range for quantitative variables&#46; We also analysed changes in immunosuppressant regimens and the combination of immunosuppressants between the follow-up years using Pearson&#8217;s chi-square tests for qualitative variables&#46; We established a significance level of <span class="elsevierStyleItalic">P</span>&#60;&#46;05&#46; For all cases in which we compared different variables at two different moments in time &#40;baseline vs 1 year post-transplantation&#41; we used paired two-tailed t-tests&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Over the course of the study&#44; the number of patients maintained within the follow-up programme was&#58; 120 &#40;end of 2<span class="elsevierStyleSup">nd</span> year&#41;&#44; 118 &#40;end of 3<span class="elsevierStyleSup">rd</span>&#41;&#44; 113 &#40;end of 4<span class="elsevierStyleSup">th</span>&#41;&#44; and 102 &#40;end of 5<span class="elsevierStyleSup">th</span>&#41;&#59; only 62 patients were monitored for 6 years&#46; The primary objective of the study&#44; patient and organ survival &#40;adjusted for patient death&#41; 5 years after KT&#44; resulted in 93&#46;1&#37; and 93&#46;8&#37;&#44; respectively &#40;determined from the survival results for all 122 cases starting at the time of the KT&#41;&#46; A total of 10 deaths were reported over the course of the study&#46; The most common causes of death were neoplasia &#40;7 of 10 cases&#41;&#59; specifically&#44; 2 lymphoma&#44; 2 brain tumours&#44; 2 pulmonary adenocarcinomas&#44; and 1 colon adenocarcinoma&#46; The majority of cancers appeared between the 5<span class="elsevierStyleSup">th</span> and 6<span class="elsevierStyleSup">th</span> years following KT&#46; The other causes of death were 2 acute myocardial infarctions &#40;in the 2<span class="elsevierStyleSup">nd</span> and 3<span class="elsevierStyleSup">rd</span> years&#41;&#44; and one gastrointestinal haemorrhage &#40;in the 3<span class="elsevierStyleSup">rd</span> year&#41;&#46; The primary cause of graft loss was death with a functioning kidney&#44; and all other failures were attributed to chronic allograft nephropathy &#40;6 cases&#41; or unknown cause &#40;2 cases&#41;&#46;</p><p class="elsevierStylePara">The mean creatinine value increased from 1&#46;60&#177;0&#46;50mg&#47;dl in the first year to 1&#46;63&#177;0&#46;70mg&#47;dl at the end of the study &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#59; mean MDRD score went from 46&#46;28&#177;15&#46;64ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> to 45&#46;69&#177;15&#46;44ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; &#40;Figure 1&#41;&#46; At the fifth year of follow-up&#44; mean Cr was 1&#46;61&#177;0&#46;60mg&#47;dl &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;068&#41;&#44; and MDRD was 45&#46;79&#177;15&#46;25ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#46; In the paired two-tailed t-test for repeated measures&#44; renal function &#40;measured by Cr or MDRD&#41; decreased significantly over time &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; although this was progressive and moderate in absolute terms&#46; These comparisons do not take into account the effect of positive selection in terms of deaths &#40;patients with better initial renal function tend to survive longer&#41;&#46; Analysing patients that reached the 6<span class="elsevierStyleSup">th</span> year of follow-up as a separate group&#44; mean Cr went from 1&#46;49&#177;0&#46;40mg&#47;dl in the first year to 1&#46;69&#177;0&#46;70mg&#47;dl in the 6<span class="elsevierStyleSup">th</span> year &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#59; mean MDRD in this group went from 49&#46;40&#177;14&#46;54ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> in the first year to 48&#46;62&#177;14&#46;31ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> in the sixth year &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; This change&#44; which was quantitatively somewhat higher than in the overall group&#44; is still not very clinically relevant&#46;</p><p class="elsevierStylePara">Only 2 cases of acute rejection were recorded after the first year of follow-up&#44; both of which were associated with by T-cells and occurred during the second year&#44; with IA and IIA histological classifications &#40;Banff criteria&#41; and a good response to steroid bolus treatment&#46; The level of compliance with the initial immunosuppression scheme was very high&#44; such that&#44; after 5 years&#44; 92&#37; of patients continued treatment with TC and 80&#37; continued with MMF &#40;Figure 2&#41;&#46; The most common cause of withdrawal of MMF was an attempt to reduce immunosuppression dosage&#44; followed by gastrointestinal toxicity and haematological toxicity &#40;leucopoenia&#41;&#46; The mean TC dose was progressively reduced from 4&#46;09mg&#47;day at the end of the first year to 2&#46;95mg&#47;day at the end of the fifth year&#44; with mean trough blood levels of 7&#46;35ng&#47;ml and 6&#46;2ng&#47;ml&#44; respectively &#40;Figure 3&#41;&#46; The mean dose of MMF remained fairly stable from the second year onwards&#44; and was 997mg&#47;day at the fifth year&#46; Steroids were suspended in the second year in 38&#37; of patients&#44; and in the sixth year in 48&#37;&#46; In a small group that constituted 4&#37; of the total at the end of the study&#44; a PSI was also administered&#46; In another small group of 2&#46;4&#37; of patients&#44; azathioprine was started&#44; in the second year in almost all cases&#44; and was maintained until the end of the study &#40;Figure 2&#41;&#46;</p><p class="elsevierStylePara">Throughout the follow-up period&#44; concomitant medication was increased in order to provide better control of the most frequently risk factors in these patients&#46; Anti-hypertensive drugs&#44; which were used by 76&#37; of patients at the end of the first year&#44; were employed in 92&#46;9&#37; of patients at the end of the fifth year&#59; statin use rose from 32&#46;6&#37; to 63&#37; over this same interval&#44; erythropoietin use rose from 8&#46;7&#37; to 18&#46;4&#37;&#44; and oral anti-diabetic and&#47;or insulin drug use rose from 9&#46;8&#37; to 15&#46;7&#37;&#59; all of these differences in drug use were statistically significant&#46; A total of 19 cardiovascular events occurred in 12 patients over the course of the study&#58; 3 acute myocardial infarctions &#40;2 of which caused patient death&#41;&#44; 2 strokes&#44; and 14 peripheral arteriopathies&#46; At least one type of cancer was observed in 14&#46;3&#37; of patients &#40;and more than 1 was observed in 4&#37;&#41;&#46; Skin cancer was the most common form of neoplasia &#40;50&#37;&#41;&#44; while post-transplant lymphoproliferative syndrome accounted for 11&#37; and other solid tumours constituted 39&#37;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The waiting lists for KT programmes show a growing proportion of older patients&#46; At the same time&#44; the mean donor age has increased in recent years&#44; with a consequently higher rate of associated cardiovascular pathology and functional deterioration of the transplant&#46; This has led to an increasing practice of transplanting organs from elderly donors and those with expanded criteria into elderly recipients&#46; The validity of assigning these organs to elderly recipients has been shown in several studies&#46;<span class="elsevierStyleSup">19&#44;20</span></p><p class="elsevierStylePara">Some authors have suggested that the rate of rejection in elderly recipients is lower due to the less active or quiescent immune system in these patients&#46; While the results extracted from large studies of the United Network for Organ Sharing &#40;UNOS&#41; appear to confirm this hypothesis&#44; other authors examining more recent patient groups have not observed a large difference in the rate of acute rejection between young and elderly recipients&#46;<span class="elsevierStyleSup">21&#44;22</span> On the other hand&#44; the lower functional reserve inherent to the decreased nephron mass in elderly donors&#44; as well as the reduced capacity for regeneration of the tissues after rejection&#44; makes the case for a more negative impact on graft survival&#44; compared young recipients&#46;<span class="elsevierStyleSup">23</span></p><p class="elsevierStylePara">There is a higher rate of associated comorbidities in elderly patients&#44; such as diverticulosis&#44; urinary tract anomalies&#44; cardiovascular pathology&#44; and diabetes&#44; among others&#44; as well as a higher incidence of cancer&#46;<span class="elsevierStyleSup">21&#44;24</span> As such&#44; the risk of suffering severe infections and tumour-related diseases following immunosuppression therapy is higher&#44; and the rate of mortality due to these processes is higher than in young recipients&#46;<span class="elsevierStyleSup">25</span> These factors require an adapted immunosuppression regimen for the specific characteristics of the donor and the recipient&#46; This protocol must be sufficiently effective to avoid rejection &#40;because of the lower graft survival rate and the higher risk of infection associated with treatment&#41; but must not lead to over-immunosuppression&#44; which could increase the number of infections and tumours in more susceptible recipients&#46; However&#44; we also lack prospective multi-centre studies with a randomised design that have analysed this issue in large cohorts of patients&#46; In addition&#44; elderly recipients are frequently excluded from trials of new immunosuppressant treatments due to the possibility of secondary side effects associated with altered pharmacokinetics that might impede the interpretation of study results&#46; The need for reducing the nephrotoxicity associated with CNI&#44; whose effects may be exacerbated by ischaemia-reperfusion damage&#44; thus preserving the largest nephron mass possible&#44; makes prescriptions that minimise or fully eliminate CNI of special interest in this group of recipients&#46;<span class="elsevierStyleSup">21&#44;26</span></p><p class="elsevierStylePara">Induction with anti-lymphocyte antibodies or anti-IL-2 is very useful for reducing the prevalence of acute rejection&#46; Given the lower risk of severe infection or cancer associated with their use&#44; IL-2 antibody receptor antagonists may be preferable over thymoglobulin in recipients with a low immunological risk&#58; the rate of acute rejection does not vary by much&#44; but this does provide a better safety profile&#46;<span class="elsevierStyleSup">26&#44;27</span></p><p class="elsevierStylePara">Arbogast et al<span class="elsevierStyleSup">15</span> treated patients without CNI using MMF doses adjusted to maintain trough levels of 2-6&#181;g&#47;ml and induction with mono-polyclonal antibodies in recipients and donors of a similar age to our study&#46; They observed a 5-year survival rate of 87&#46;69&#37; and a graft survival rate of 69&#46;8&#37; &#40;adjusted for patient death and non-immunological causes&#58; 86&#46;57&#37;&#41;&#44; although this was lower than in our study and involved a much higher rate of acute rejection &#40;23&#46;6&#37;&#41;&#46;<span class="elsevierStyleSup">15</span> Later publications from this same group observed similar results with even higher rejection rates&#44; which led to 46&#46;3&#37; of patients receiving and added CNI in their treatment regimens&#46; Despite the good survival rates observed in comparison to other studies involving treatment with CNI&#44; the high rates of rejection and cytomegalovirus infection &#40;requiring a reduction of MMF and the introduction of CNI or PSI&#41; place doubts on the validity of immunosuppression regimens without CNI&#46;<span class="elsevierStyleSup">28&#44;29</span></p><p class="elsevierStylePara">In a controlled study &#40;SENIOR&#41;&#44; no advantages were observed with a delayed introduction of TC &#40;after 7 days&#44; after complete withdrawal of steroid treatment&#41; as compared to immediate use&#44; in terms of frequency&#44; duration of functional delay&#44; or renal function after 6 months&#46;<span class="elsevierStyleSup">30</span> The mean duration of functional delay in the case of donors older than 60 years with a delayed introduction of TC was 19 days&#44; much higher than in our study &#40;7 days&#44; with a median of 4 days&#41;&#59; the frequency of early acute rejection was also much higher in this study than in ours&#46; Previous studies also failed to demonstrate an advantage of delayed TC introduction with depletive antibody<span class="elsevierStyleSup">31</span> or cyclosporine<span class="elsevierStyleSup">32</span> induction in terms of the incidence of delayed function&#46; However&#44; initial CNI doses and levels in these studies were standard and higher than in ours&#46; In all likelihood&#44; the appearance of delayed graft function requiring dialysis is mediated by factors that come into play prior to immunosuppression therapy &#40;donor age&#44; vasculopathy&#44; cause of death&#44; conditions surrounding donor suffering&#44; cold ischaemia&#44; etc&#46;&#41; and cannot be modified by a delayed introduction of CNI&#46; In contrast&#44; lower doses and blood levels &#40;with or without delayed introduction&#41; may be more useful for shortening its duration&#46; The results of the Symphony study<span class="elsevierStyleSup">33</span> attest to the efficacy and safety of an immunosuppressant regimen with low initial doses of TC&#46;</p><p class="elsevierStylePara">In a study involving 72 patients older than 60 years&#44; Sol&#224; et al&#46; assessed the results of a treatment regimen based on steroids&#44; MMF&#44; and TC&#44; with the addition of thymoglobulin and a delayed start of TC &#40;at 1mg&#47;kg&#47;day&#44; similar to our study&#41; upon delayed graft function &#40;which occurred in 48&#46;6&#37; of cases&#41;&#46; This led to a rapid resolution of delayed graft function cases &#40;mean 3&#46;9 days&#41; and a 12&#46;5&#37; rejection rate&#46; Patient survival after 3 years was 90&#37;&#44; and graft survival was 87&#37; &#40;97&#37; after adjusting for patient death&#41;&#46;<span class="elsevierStyleSup">34</span></p><p class="elsevierStylePara">In our experience&#44; the use of this treatment regimen produces very satisfactory results in terms of mid-term patient and organ survival&#44; with even better rates than those observed in other studies&#46;<span class="elsevierStyleSup">29</span> As in previous studies&#44; the primary cause of graft loss was patient death&#44; primarily due to cancer&#46; None of the deaths in our study were due to infections&#46; The rate of acute rejection after the first year was low&#44; showing a sufficient level of immunosuppression&#46; Deterioration of renal function was very mild&#44; with excellent Cr and GFR rates at the end of the fifth year&#46; We also observed a very high level of compliance with the prescribed immunosuppression protocol&#44; as most patients remained on the planned MMF&#47;TC regimen&#46; There was a clear tendency for the maintenance of trough TC values at the upper limit of the predicted range during the first years of follow-up&#44; although these values became more moderate over the course of the study&#46; This is probably due to the minimal treatment applied when using a conservative approach&#44; as observed in large studies such as the Symphony study&#46;<span class="elsevierStyleSup">33</span></p><p class="elsevierStylePara">The design of our study had some methodological weaknesses&#44; such as the retrospective nature of the study and the lack of a control group treated with an immunosuppression regimen without delayed introduction and minimal doses of CNI&#44; as we explained in our previous publication&#46; Prospective studies without these limitations and involving a larger number of patients would be needed to establish how appropriate this type of immunosuppression therapy would be for the transplantation of organs from elderly or expanded criteria donors into elderly recipients&#46;</p><p class="elsevierStylePara">In conclusion&#44; we believe that the treatment regimen used in our study&#44; involving induction with two doses of daclizumab&#44; along with MMF and a late introduction of TC at low doses&#44; is useful and appropriate for elderly donor-recipient pairs&#44; as shown by the good long-term survival results and the maintenance of optimal renal function and acceptable safety profiles&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11024&#95;16025&#95;31545&#95;en&#95;t1a11024en&#46;jpg" class="elsevierStyleCrossRefs"><img src="11024_16025_31545_en_t1a11024en.jpg" alt="Patient characteristics after one year"></img></a></p><p class="elsevierStylePara">Table 1&#46; Patient characteristics after one year</p><p class="elsevierStylePara"><a href="grande&#47;11024&#95;16025&#95;31546&#95;en&#95;f1a11024en&#46;jpg" class="elsevierStyleCrossRefs"><img src="11024_16025_31546_en_f1a11024en.jpg" alt="Evolution of renal function"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Evolution of renal function</p><p class="elsevierStylePara"><a href="grande&#47;11024&#95;16025&#95;31547&#95;en&#95;f2a11024en&#46;jpg" class="elsevierStyleCrossRefs"><img src="11024_16025_31547_en_f2a11024en.jpg" alt="Use of immunosuppressants &#40;&#37; of all patients&#41; in each year following transplantation"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Use of immunosuppressants &#40;&#37; of all patients&#41; in each year following transplantation</p><p class="elsevierStylePara"><a href="grande&#47;11024&#95;16025&#95;31548&#95;en&#95;f3a11024en&#46;jpg" class="elsevierStyleCrossRefs"><img src="11024_16025_31548_en_f3a11024en.jpg" alt="Evolution of tacrolimus trough blood levels throughout the study"></img></a></p><p class="elsevierStylePara">Figure 3&#46; Evolution of tacrolimus trough blood levels throughout the study</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes</span><span class="elsevierStyleBold">&#58;</span> El trasplante de &#243;rganos de donantes a&#241;osos en receptores de edad avanzada se ha incrementado en los &#250;ltimos a&#241;os&#46; Esta situaci&#243;n plantea problemas espec&#237;ficos tanto en el &#243;rgano como en el receptor&#44; y la pauta de inmunosupresi&#243;n debe ser adaptada a ellos&#46; Un estudio previo mostr&#243; buenos resultados iniciales en el trasplante renal de donante y receptor a&#241;osos &#40;medias de edad&#58; 64&#44;4 y 61&#44;3 a&#241;os&#41; con una inmunosupresi&#243;n inicial de daclizumab&#44; mofetil-micofenolato e introducci&#243;n retrasada de tacrolimus a dosis bajas&#46; En el presente estudio revisamos los resultados a largo plazo en ese mismo grupo de pacientes&#46; <span class="elsevierStyleBold">M&#233;todos&#58;</span>&#160;Estudio observacional&#44; retrospectivo y multic&#233;ntrico a nivel nacional de la supervivencia y funci&#243;n renal de 126 pacientes incluidos en el estudio inicial &#40;sobre 127 que alcanzaron el primer a&#241;o con ri&#241;&#243;n funcionante&#44; 123 tratados seg&#250;n protocolo&#41;&#46; Obtuvimos datos del segundo al sexto a&#241;o de&#58; 120&#44; 118&#44; 113&#44; 102 y 62&#160;pacientes&#46; Secundariamente se analiz&#243; la evoluci&#243;n de la funci&#243;n renal&#44; aspectos cl&#237;nicos relevantes y el perfil de seguridad&#46; <span class="elsevierStyleBold">Resultados&#58;</span><span class="elsevierStyleBold">&#160;</span>A los 5 a&#241;os&#44; la mayor&#237;a de los casos continuaban con el esquema inmunosupresor inicial&#58; 92&#37; tacrolimus y 80&#37; mofetil-micofenolato&#59; 48&#37; hab&#237;an abandonado los esteroides y se introdujo un inhibidor de la se&#241;al de proliferaci&#243;n en 3&#37;&#46; La supervivencia del paciente y el &#243;rgano &#40;censurada para muerte&#41; a los 5 a&#241;os result&#243; de 93&#44;1 y 93&#44;8&#37;&#44; respectivamente&#46; La principal causa de muerte fue la neoplasia &#40;en 7 de los 10 casos&#41; y&#44; de p&#233;rdida de injerto&#44; la muerte con ri&#241;&#243;n funcionante&#46; Las otras causas de muerte fueron 2 infartos agudos de miocardio&#160;y una hemorragia digestiva&#46;&#160;La funci&#243;n renal se redujo significativa pero moderadamente a lo largo del tiempo &#40;p &#60; 0&#44;001&#41;&#58; la creatinina media en el conjunto de pacientes pas&#243; de 1&#44;60 &#177; 0&#44;50 mg&#47;dl al primer a&#241;o a 1&#44;63 &#177; 0&#44;70 al cierre del estudio &#40;p &#60; 0&#44;05&#41;&#59; MDRD de 46&#44;28 &#177; 15&#44;64 ml&#47;min al primer a&#241;o a 45&#44;69 &#177; 15&#44;44 al cierre del estudio &#40;p &#60; 0&#44;01&#41;&#46; S&#243;lo se registraron 2 rechazos agudos despu&#233;s del primer a&#241;o&#46; Se registraron 19 eventos cardiovasculares en 12 pacientes&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span><span class="elsevierStyleBold">&#160;</span>La pauta utilizada en nuestro estudio resulta &#250;til y adecuada para parejas donante-receptor de mayor edad&#44; como demuestran los buenos resultados en supervivencia a largo plazo&#44; y el mantenimiento de una &#243;ptima funci&#243;n renal y un perfil de seguridad aceptables&#46;&#160;</p> <p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Organ transplants in elderly recipients have increased over the past few years&#46; This situation poses specific problems both in terms of organs and recipients&#59; therefore&#44; immunosuppressant regimens must be adapted accordingly&#46; A previous study demonstrated good initial results in kidney transplant cases in which older donors and recipients &#40;average ages of 64&#46;4 years and 61&#46;3 years&#41; had received initial immunosuppressant therapy with daclizumab and mycophenolate mofetil as well as delayed introduction of reduced-dose tacrolimus&#46; In this study we reviewed the long-term results in the same group of patients&#46; <span class="elsevierStyleBold">Methods&#58;</span> An observational&#44; retrospective multi-centre study carried out at a national level to determine survival rates and renal function in 126 patients included in the initial study &#40;127 patients who survived the first year with a functioning graft&#44; 123 treated according to protocol&#41;&#46; We gathered data from the 2<span class="elsevierStyleSup">nd</span>&#160;to the 6<span class="elsevierStyleSup">th</span>&#160;year for 120&#44; 118&#44; 113&#44; 102 and 62 patients&#44; respectively&#46; The evolution of renal function&#44; relevant clinical data&#44; and safety profiles were also analysed&#46; <span class="elsevierStyleBold">Results&#58; </span>After five years&#44; most patients continued with the initial immunosuppressant regimen&#58; 92&#37; tacrolimus and 80&#37; mycophenolate mofetil&#59; 48&#37; had abandoned steroids and proliferation signal inhibitors had been introduced in 3&#37;&#46; Patient and graft survival &#40;adjusted for patient death&#41; after five years was 93&#46;1&#37; and 93&#46;8&#37;&#44; respectively&#46; The main cause of death was neoplasia &#40;in 7 out of 10 cases&#41; whilst graft loss was mainly due to death with a functioning graft&#46; The other causes of death were 2 acute myocardial infarctions and a gastrointestinal haemorrhage&#46; Renal function was moderately but significantly reduced with the passing of time &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#58; average creatinine levels in the overall group of patients rose from 1&#46;60&#177;0&#46;50mg&#47;dl after the 1<span class="elsevierStyleSup">st</span>&#160;year to 1&#46;63&#177;0&#46;70mg&#47;dl at the end of study&#46; MDRD dropped from 46&#46;28&#177;15&#46;64ml&#47;min after the 1<span class="elsevierStyleSup">st</span>&#160;year to 45&#46;69&#177;15&#46;44ml&#47;min at the end of study &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#46; Only two acute rejections were observed after the 1<span class="elsevierStyleSup">st</span>&#160;year&#46; There were 19 cardiovascular events registered in 12 patients&#46; <span class="elsevierStyleBold">Conclusions&#58; </span>The regimen used in our study was useful and appropriate for elderly donor-recipient pairs as demonstrated by the good long-term survival results&#44; continued optimum renal function&#44; and acceptable safety profile&#46;&#160;</p>"
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                  "referenciaCompleta" => "Danovitch GM, Cohen DJ, Weir MR,\u{A0}Stock PG,\u{A0}Bennett WM,\u{A0}Christensen LL,\u{A0}et al. Current status of kidney and pancreas transplantation in the United States, 1994¿2003. Am J Transplant 2005;5:904-15."
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                  "referenciaCompleta" => "Wolfe RA, Ashby VB, Milford EL, Ojo AO,\u{A0}Ettenger RE,\u{A0}Agodoa LY,\u{A0}et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10580071" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Fijter JW.The impact of Age on rejection in kidney transplantation. Review article. Drugs aging 2005;22(5)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              "etiqueta" => "4"
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                0 => array:3 [
                  "referenciaCompleta" => "Doyle SE, Matas AJ, Gillingham K, Rosenberg ME. Predicting clinical outcome in the elderly renal transplant recipient. Kidney Int 2000;57:2144-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10792636" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "referenciaCompleta" => "Reutzel-Selke A,\u{A0}Filatenkov A,\u{A0}Jurisch A,\u{A0}Denecke C,\u{A0}Martins PN,\u{A0}Pascher A,\u{A0}et al. Grafts from elderly donors elicit a stronger immune response in the early period post transplantation: a study in a rat model. Transplant Proc 2005;37(1):382-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15808652" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Oniscu GC, Brown H, Forsythe JL. How old is old for transplantation? Am J Transplant 2004;4:2067-74. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15575911" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Danovitch G, Savransky E. Challenges in the counseling and management of older kidney transplant candidates. Am J Kidney Dis 2006;47(4 Suppl 2):S86-97. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16567243" target="_blank">[Pubmed]</a>"
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                0 => array:3 [
                  "referenciaCompleta" => "Meier-Kriesche HU, Kaplan B. Immunosuppression in elderly renal transplant recipients: Are current regimens too aggressive? Drugs Aging 2001;18:751-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11735622" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Bernardo JF, McCauley J. Drug therapy in transplant recipients: special considerations in the elderly with comorbid conditions. Drugs Aging 2004;21:323-48. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15040759" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Zeeh J, Platt D. The aging liver: structural and functional changes and their consequences for drug treatment in old age. Gerontology 2002;48:121-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11961363" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Meier-Kriesche HU, Ojo AO, Cibrik DM,\u{A0}Hanson JA,\u{A0}Leichtman AB,\u{A0}Magee JC,\u{A0}et al. Relationship of recipient age and development of chronic allograft failure. Transplantation 2000;70:306-10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10933154" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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            11 => array:3 [
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              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Olyaei AJ, De Mattos AM, Bennett WM. Nephrotoxicity of immunosuppressive drugs: new insight and preventive strategies. Curr Opin Crit Care 2001;7 (6):384-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11805539" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Grinyo JM, Cruzado JM. Steroid or calcineurin inhibitor-sparing immunosuppressive protocols. Contrib Nephrol 2005;146:30-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15567918" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lo A. Strategies to prevent chronic allograft nephropathy in kidney transplantation: focus on calcineurin inhibitors. Prog Transplant 2004;14(2):157-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15264460" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Arbogast H, Huckelheim H, Schneeberger H,\u{A0}Illner WD,\u{A0}Tarabichi A,\u{A0}Fertmann J,\u{A0}et al. A calcineurin antagonist-free induction/maintenance strategy for immunosuppression in elderly recipients of renal allografts from elderly cadaver donors: Long-term results from a prospective single centre trial. Clin Transplant 2005;19:309. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15877790" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Emparan C, Wolters H, Laukotter M, Senninger N. Long-term results of calcineurin-free protocols with basiliximab induction in ¿old-toold¿ programs. Transplant Proc 2004;36:2646-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15621113" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kuypers DR. Benefit-risk assessment of sirolimus in renal transplantation. Drug Saf 2005;28(2):153-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15691225" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gentil MA, Osuna A, Capdevilla L, Canterell C, Pereira P, Mazuecos A, et al. Daclizumab en combinación con micofenolato mofetil e introducción tardía de tacrolimus a dosis bajas, como opción terapéutica en la pareja donante-receptor añoso en trasplante renal. Nefrologia 2008;28(3):287-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18590495" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Smits JM, Persijn GG, van Houwelingen HC, Claas FH, Frei U. Evaluation of the Eurotransplant Senior Program. The results of the first year. Am J Transplant 2002;2:664-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12201369" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Frei U, Noeldeke J, Machold-Fabrizzi V, Arbogast H,\u{A0}Margreiter R,\u{A0}Fricke L,\u{A0}et al. Prospective age-matching\u{A0} in elderly kidney transplant recipients ¿A 5-year analysis of the Eurotransplant Senior Program. Am J Transplant 2008;8:50-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17973969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Meier-Kriesche HU, Ojo A, Hanson J, Cibrik D,\u{A0}Lake K,\u{A0}Agodoa LY,\u{A0}et al. Increased immunosuppressive vulnerability in elderly renal transplant recipients. Transplantation 2000;69:885-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10755545" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Palomar R, Ruiz JC, Zubimendi JA, Cotorruelo JG,\u{A0}de Francisco AL,\u{A0}Rodrigo E,\u{A0}et al. Acute rejection in the elderly recipient: Influence of age in the outcome of kidney transplantation. Int Urol Nephrol 2002;33:145-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12090322" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
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            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Meier-Kriesche HU, Srinivas TR, Kaplan B. Interaction between acute rejection and recipient age on long-term renal allograft survival. Transplant Proc 2001;33:3425-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11750467" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
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            23 => array:3 [
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                0 => array:3 [
                  "referenciaCompleta" => "Trouillhet I, Benito N, Cervera C, Rivas P, Cofán F, Almela M, et al. Influence of age in renal transplant infections: cases and controls study. Transplantation 2005;80:989-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16249750" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
            ]
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Danovitch GM,\u{A0}Gill J,\u{A0}Bunnapradist S. Immunosuppression of the elderly kidney transplant recipient. Transplantation 2007;84(3):285-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17700150" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
            ]
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              "identificador" => "bib26"
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mourad G, Rostaing L, Legendre C, Garrigue V,\u{A0}Thervet E,\u{A0}Durand Dl. Sequential protocols using basiliximab versus antithymocyte globulins in renal-transplant patients receiving mycophenolate mofetil and steroids. Transplantation 2004;78:584-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15446319" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              "identificador" => "bib27"
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                0 => array:3 [
                  "referenciaCompleta" => "Lebranchu Y, Bridoux F, Buchler M, Le Meur Y,\u{A0}Etienne I,\u{A0}Toupance O,\u{A0}et al. Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF-containing triple therapy. Am J Transplant 2002;2:48-56. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12095056" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              "identificador" => "bib28"
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                0 => array:3 [
                  "referenciaCompleta" => "Guba M, Rentsch M, Wimmer CD, Uemueksuez A,\u{A0}Illner WD,\u{A0}Schönermarck U,\u{A0}et al. Calcineurin-inhibitor avoidance in elderly renal allograft recipients using ATG and basiliximab combined with mycophenolate mofetil. Transpl Int 2008;21(7):637-45. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18282242" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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              "identificador" => "bib29"
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pascual J,\u{A0}Zamora J,\u{A0}Pirsch JD. A systematic review of kidney transplantation from expanded criteria donors. Am J Kidney Dis 2008;52(3):553-86.\u{A0} <a href="http://www.ncbi.nlm.nih.gov/pubmed/18725015" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Andrés A,\u{A0}Budde K,\u{A0}Clavien PA, Becker T, Kessler M, Pisarski P, et al. A randomized trial comparing renal function in older kidney transplant patients following delayed versus immediate tacrolimus administration. Transplantation 2009;88(9):1101-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19898206" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Mourad G, Garriague V, Squifflet JP, Besse T, Berthoux F, Alamartine E, et al. Induction vs. Noninduction\u{A0} in renal transplant recipients with tacrolimus-based immunosuppression. Transplantation 2001;72:1050-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11579299" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Kamar N, Garrigue V, Karras A, Mourad G, Lefrançois N, Charpentier E, et al. Impact of early or delayed cyclosporin on delayed graft function in renal transplant recipients: A randomized, multicenter study. Am J Transplant 2006;6:1042-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16611342" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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              "etiqueta" => "33"
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                0 => array:3 [
                  "referenciaCompleta" => "Ekberg H, Tedesco-Silva H, Demirbas A, Vitko S, Nashan B, Gurkan A, et al.; ELITE-Symphony Study. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med 2007;357(25):2562-75. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18094377" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Solà R, Guirado L, Díaz JM, Facundo C, Gich I, Chuy E, et al. Tacrolimus/mycophenolate mofetil-based immunosuppression in aged kidney transplant. A prospective study. Int Immunopharmacol 2005;5(1):129-31. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15589471" target="_blank">[Pubmed]</a>"
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Article information

ISSN: 20132514
Original language: English

DOI:10.3265/Nefrologia.pre2012.Mar.11024

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Year/Month	Html	Pdf	Total

2024 November	13	9	22
2024 October	59	48	107
2024 September	56	30	86
2024 August	66	59	125
2024 July	48	33	81
2024 June	72	36	108
2024 May	77	38	115
2024 April	78	33	111
2024 March	69	25	94
2024 February	46	37	83
2024 January	36	21	57
2023 December	53	25	78
2023 November	49	37	86
2023 October	98	29	127
2023 September	136	29	165
2023 August	39	17	56
2023 July	40	25	65
2023 June	33	22	55
2023 May	47	31	78
2023 April	28	17	45
2023 March	68	25	93
2023 February	36	17	53
2023 January	53	34	87
2022 December	43	33	76
2022 November	54	34	88
2022 October	51	35	86
2022 September	46	32	78
2022 August	36	37	73
2022 July	33	43	76
2022 June	32	44	76
2022 May	31	20	51
2022 April	35	43	78
2022 March	42	54	96
2022 February	40	39	79
2022 January	66	28	94
2021 December	50	35	85
2021 November	41	32	73
2021 October	44	36	80
2021 September	38	38	76
2021 August	28	41	69
2021 July	29	29	58
2021 June	28	18	46
2021 May	38	35	73
2021 April	81	53	134
2021 March	52	37	89
2021 February	43	16	59
2021 January	34	18	52
2020 December	28	16	44
2020 November	38	17	55
2020 October	28	21	49
2020 September	24	12	36
2020 August	41	16	57
2020 July	44	18	62
2020 June	24	22	46
2020 May	41	14	55
2020 April	27	11	38
2020 March	27	14	41
2020 February	34	22	56
2020 January	57	25	82
2019 December	35	26	61
2019 November	48	21	69
2019 October	25	7	32
2019 September	33	21	54
2019 August	31	7	38
2019 July	32	16	48
2019 June	38	15	53
2019 May	38	16	54
2019 April	79	23	102
2019 March	38	16	54
2019 February	33	17	50
2019 January	46	17	63
2018 December	117	45	162
2018 November	109	15	124
2018 October	74	7	81
2018 September	75	18	93
2018 August	52	18	70
2018 July	60	11	71
2018 June	61	20	81
2018 May	59	14	73
2018 April	72	11	83
2018 March	54	4	58
2018 February	46	6	52
2018 January	42	6	48
2017 December	57	6	63
2017 November	59	10	69
2017 October	45	4	49
2017 September	61	13	74
2017 August	39	14	53
2017 July	38	11	49
2017 June	39	10	49
2017 May	42	19	61
2017 April	45	16	61
2017 March	40	9	49
2017 February	31	19	50
2017 January	21	10	31
2016 December	75	11	86
2016 November	115	19	134
2016 October	138	6	144
2016 September	150	3	153
2016 August	201	9	210
2016 July	202	8	210
2016 June	145	0	145
2016 May	139	0	139
2016 April	106	0	106
2016 March	111	0	111
2016 February	134	0	134
2016 January	132	0	132
2015 December	134	0	134
2015 November	134	0	134
2015 October	132	0	132
2015 September	82	0	82
2015 August	83	0	83
2015 July	66	0	66
2015 June	50	0	50
2015 May	47	0	47
2015 April	5	0	5

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