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Use of defibrotide in renal transplantation in man
Insights
Defibrotide significantly reduced graft loss in transplant patients compared to dipyridamole. This new antithrombotic agent shows promise in preventing vascular rejection and maintaining kidney graft function.
Area of Science:
- Nephrology
- Transplantation Immunology
- Vascular Biology
Background:
- Graft rejection, particularly vascular rejection, is a major complication post-transplant, leading to graft loss.
- Current therapies for vascular rejection are often inadequate, highlighting the need for effective prevention strategies.
Purpose of the Study:
- To evaluate the efficacy of a novel antithrombotic agent, defibrotide, in preventing vascular rejection and preserving renal graft function.
- To compare the outcomes of defibrotide treatment with dipyridamole in kidney transplant recipients.
Main Methods:
- A comparative study involving 22 kidney transplant patients receiving defibrotide (Group A) and 30 patients receiving dipyridamole (Group B) post-surgery.
- Follow-up ranged from 6-19 months for Group A and 5-21 months for Group B, monitoring for rejection episodes and graft function.
Main Results:
- All patients treated with defibrotide maintained normally functioning grafts at follow-up.
- In contrast, 73% of patients on dipyridamole had satisfactory graft function, with 7 requiring graft removal due to severe vascular lesions.
Conclusions:
- Defibrotide demonstrated superior efficacy in preventing vascular rejection and preserving renal graft function compared to dipyridamole.
- Early post-operative administration of defibrotide represents a promising preventive approach for kidney transplant recipients.
Abstract:
In transplanted patients graft rejection is the most frequent complication in the first year after surgery. Vascular lesions (necrosis, intimal proliferation, thrombosis) are signs of poor prognosis and lead to irreversible loss of renal function and graft removal in most cases. The problem of vascular rejection is still not solved and the results of therapy unsatisfactory, both because of inadequacy of diagnosis and/or inadequacy of available therapy. The role of prevention, very likely the best approach, is still sub judice. In an attempt to explore the validity of prevention, 22 transplanted patients (group A) were given a new antithrombotic agent (defibrotide) immediately after surgery, and the results were compared with those of a well-matched group of 30 patients on dipyridamole (group B). Follow-up lasted 6-19 months (mean 9.9) for group A; 5-21 months (mean 12) for group B. In group A, 8 patients (36%) had rejection episodes. Antirejection therapy was followed by recovery of renal function in all cases. In group B, 9 patients (29%) had rejection crises and graft removal was necessary in 7 instances due to severe vascular lesions. At the end of follow-up, all patients treated with defibrotide had normally functioning grafts: among the 30 patients on dipyridamole, 22 (73%) had satisfactory graft function.