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Titolo:
Predicting factors of long-term results of OKT3 therapy for steroid resistant acute rejection following cadaveric renal transplantation
Autore:
Rostaing, L; Chabannier, MH; Modesto, A; Rouzaud, A; Cisterne, JM; Tkaczuk, J; Durand, D;
Indirizzi:
Toulouse Univ Hosp, Multiorgan Transplant Unit, Toulouse, France Toulouse Univ Hosp Toulouse France an Transplant Unit, Toulouse, France Toulouse Univ Hosp, Immunol Lab, Toulouse, France Toulouse Univ Hosp Toulouse France Hosp, Immunol Lab, Toulouse, France Toulouse Univ Hosp, Dept Epidemiol, Toulouse, France Toulouse Univ Hosp Toulouse France sp, Dept Epidemiol, Toulouse, France
Titolo Testata:
AMERICAN JOURNAL OF NEPHROLOGY
fascicolo: 6, volume: 19, anno: 1999,
pagine: 634 - 640
SICI:
0250-8095(199911/12)19:6<634:PFOLRO>2.0.ZU;2-0
Fonte:
ISI
Lingua:
ENG
Soggetto:
MONOCLONAL-ANTIBODY OKT3; ALLOGRAFT REJECTION; RANDOMIZED TRIAL; RECIPIENTS; CYCLOSPORINE; ALG;
Keywords:
steroid resistant acute rejection; renal transplantation; OKT3; renal allograft histology; graft survival;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
23
Recensione:
Indirizzi per estratti:
Indirizzo: Rostaing, L CHU Rangueil, Serv Nephrol Transplantat Organes, 1 Ave Jean Poulhes, F-31054 Toulouse, France CHU Rangueil 1 Ave Jean Poulhes Toulouse France F-31054 rance
Citazione:
L. Rostaing et al., "Predicting factors of long-term results of OKT3 therapy for steroid resistant acute rejection following cadaveric renal transplantation", AM J NEPHR, 19(6), 1999, pp. 634-640

Abstract

In this retrospective study, we evaluated the histological and biological predictors of long-term response of renal transplant (RT) patients treated with orthoclone OKT3 for steroid resistant acute rejection (AR). Seventy-three patients, aged 37 +/- 12 years, were included in this study between March 1987 and December 1996. All the patients but one had received sequentialquadruple immunosuppression (polyclonal antilymphocyte globulins; steroids; azathioprine, and cyclosporin A). OKT3 (5 mg/day for 10 days) was administered for biopsy-proven steroid resistant AR i.e., after 3 consecutive pulses of methylprednisolone (10 mg/kg each). This was the first AR in 46 cases, the second AR in 22 cases and the third AR in 4 cases. Renal histology (Banff) showed borderline (BL) changes in 18 patients, grade I AR in 28 patients; grade II AR in 22 patients, and grade III AR in 5 patients. When treatment with OKT3 commenced (107 +/- 18 days post-transplantation) the mean serum creatinine (SCr) level was 325 +/- 195 mu mol/l; this had decreased to 191 +/- 106 mu mol/l by the end of OKT3 therapy. The immediate response to OKT3 therapy i.e., within the first month, was not dependent on the histological score. Twenty-six patients (35%) subsequently experienced at least one more AR episode of whom 4 were retreated with OKT3. The overall patient'ssurvival was 94.5% at last follow-up. The overall cumulative graft: survival was 64.5% at 2 years, 52.5% at 5 years, and 40.5% at 8 years. The graft survival (5 years) tended to depend on the initial histological score, i.e. BL 30%; grade I 66%; grades II and III 55.5% (p = 0.08). In a multiple logistic regression analysis we tried to identify independent factors that would predict that a graft would still be functioning at least 2 years after OKT3 therapy. We therefore analyzed the following parameters: donor and recipient's age; gender; cold ischemia lime; HLA matching; panel reactive antibodies (PRA) prior to grafting; previous transplantation(s); total number ofAR episodes; the time of onset of the AR treated by OKT3 compared to the other AR; the time of onset of the AR treated by OKT3; SCr levels at days 0,10 and 30 after OKT3 therapy; histological score (Banff) i.e., the magnitude of AR and the presence or absence of chronic lesions. The only independent factors which would predict that a graft was still functioning 2 years after OKT3 therapy were: PRA <25% (Odds ratio (OR) 7.68 (1.15-51.3); p = 0.035); a grade I AR (OR 10.52 (1.18-93.5); p = 0.035); SCr level 1 month after OKT3 therapy (OR 0.935 (0.87-1.002); p = 0.05). HLA matching and the presence of histological chronic lesions were nearly significant (p = 0.06 and 0.09 respectively). In conclusion, this retrospective study shows that independent predictors of the long-term response to OKT3 therapy for AR in RT patients are the magnitude of pre-transplant PRA, the histological score, and the SCr level one month after OKT3 therapy. Copyright (C) 1999 S. Karger AG, Basel.

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Documento generato il 11/07/20 alle ore 21:11:19