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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
Published on: November 8, 2015
From cyclosporine to the future
C Ponticelli1, A Tarantino, M Campise
1Division of Nephrology, Ospedale Maggiore IRCCS, Milano, Italy. Ponticelli@policlinico.mi.it
Transplantation Proceedings
|March 26, 2004
Summary
Cyclosporine (CsA) demonstrates improved long-term graft survival in kidney transplant patients compared to azathioprine. Monotherapy with CsA reduces side effects, while basiliximab addition lowers acute rejection rates.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation
Background:
- Cyclosporine (CsA) is a cornerstone of immunosuppression in renal transplantation.
- Extensive clinical trials have evaluated various CsA-based regimens.
- Long-term outcomes and side effect profiles remain critical considerations.
Purpose of the Study:
- To review cumulative experience with CsA in renal transplantation.
- To assess the efficacy and safety of different CsA-based immunosuppressive strategies.
- To identify current challenges and future directions in immunosuppression.
Main Methods:
- Analysis of data from multiple randomized controlled trials and multicenter studies.
- Review of cumulative patient experience and graft survival data.
- Inclusion of ongoing trials investigating novel immunosuppressive agents.
Main Results:
- CsA-treated patients showed better 10-year graft survival than azathioprine.
- CsA monotherapy and double/triple therapy demonstrated similar long-term graft survival, with monotherapy having fewer steroid side effects.
- Addition of basiliximab to triple therapy reduced acute rejection without increasing side effects.
- Mean graft half-life was 18.7 years for cadaver and 31.9 years for living donors.
- No significant graft function decline observed in grafts functioning at 15 years.
Conclusions:
- CsA-based immunosuppression offers favorable long-term graft survival in renal transplantation.
- Minimizing steroid use through monotherapy or alternative agents is beneficial.
- Ongoing research focuses on addressing calcineurin inhibitor nephrotoxicity and steroid-related cardiovascular risks with newer agents.
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