Warning: Undefined variable $zfal in C:\Inetpub\vhosts\kidney.de\httpdocs\mlpefetch.php on line 525
Deprecated: str_replace(): Passing null to parameter #3 ($subject) of type array|string is deprecated in C:\Inetpub\vhosts\kidney.de\httpdocs\mlpefetch.php on line 525
Warning: Undefined variable $sterm in C:\Inetpub\vhosts\kidney.de\httpdocs\mlpefetch.php on line 530
Warning: Undefined variable $sterm in C:\Inetpub\vhosts\kidney.de\httpdocs\mlpefetch.php on line 531
English Wikipedia
Nephropedia Template TP (
Twit Text
DeepDyve Pubget Overpricing |
lüll Management of chronic allograft nephropathy: a systematic review Birnbaum LM; Lipman M; Paraskevas S; Chaudhury P; Tchervenkov J; Baran D; Herrera-Gayol A; Cantarovich MClin J Am Soc Nephrol 2009[Apr]; 4 (4): 860-5Despite improving immunosuppressive protocols in renal transplantation, chronic allograft nephropathy (CAN) remains a major impediment to long-term graft survival. The optimal immunosuppressive regimen for a patient with CAN is unknown. The aim of this study is to evaluate the various immunosuppressive management strategies of biopsy-proven CAN and of chronic allograft dysfunction (CAD) (no biopsy). A systematic review of randomized trials (n = 12 trials with 635 patients) was conducted. Studies included patients who were >6 mo post-transplant. All patients were on a calcineurin inhibitor (CNI), most often cyclosporine, and were randomized to convert to mycophenolate mofetil (MMF), tacrolimus, or sirolimus (Rapa) or to add azathioprine, MMF or Rapa to their current regimen. Follow-up time was 6 to 36 mo. The outcome measures evaluated were renal function in 11 of 12 studies and repeat renal biopsy results in one study. The methodological quality scores of the trials were generally low, using the Jadad scale (median value 2/5). Results varied between studies but suggested that CNI withdrawal is safe and that conversion to MMF or Rapa may be beneficial. The incidence of adverse effects ranged from 0% to 68% between the studies, and medication withdrawal occurred in 0% to 24% of patients. The review did not result in a consensus regarding the management of CAN and CAD. Further studies are required to determine the best therapeutic option for patients with CAD and CAN.|Azathioprine/therapeutic use[MESH]|Biopsy[MESH]|Calcineurin Inhibitors[MESH]|Chronic Disease[MESH]|Drug Therapy, Combination[MESH]|Graft Survival/*drug effects[MESH]|Humans[MESH]|Immunosuppressive Agents/adverse effects/*therapeutic use[MESH]|Kidney Diseases/*drug therapy/etiology/pathology/physiopathology[MESH]|Kidney Function Tests[MESH]|Kidney Transplantation/*adverse effects[MESH]|Mycophenolic Acid/analogs & derivatives/therapeutic use[MESH]|Sirolimus/therapeutic use[MESH]|Tacrolimus/therapeutic use[MESH]|Time Factors[MESH]|Transplantation, Homologous[MESH]|Treatment Outcome[MESH] |