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Questions raised by the exclusion of ‘at risk’ conditions from current trials in organ transplantation

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Immunosuppression under Trial

Part of the book series: Transplantation and Clinical Immunology ((TRAC,volume 31))

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Abstract

The recent development of new immunosuppressive agents may improve the overall results of organ transplantation and open new areas for clinical applications of allografts. The introduction of cyclosporin A 20 years ago brought drastic improvements in liver and heart transplantation, and these became routine treatment for irreversible hepatic or cardiac failure. New immuno-suppressors may have a comparable effect on lung, heart—lung and intestinal transplantation. However the whole clinical field of organ transplantation is moving: improvement in short-term results has led to such treatments being offered to ‘high-risk’ patients who were formerly excluded from transplantation: carefully designed clinical studies demonstrated that very young or elderly recipients, as well as diabetics or hyperimmunized patients could benefit from such treatments. Because of organ shortage, donors who were initially excluded for various reasons have finally become acceptable since cold ischemia time can be prolonged in kidney transplantation without major changes in failure rate.

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References

  1. Pearson TC, Madsen JC, Larsen CP, Morris PJ, Wood KJ. Induction of transplantation tolerance in adults using donor antigen and anti-CD4 monoclonal antibody. Transplantation. 1992; 54: 475–483.

    Article  PubMed  CAS  Google Scholar 

  2. Genyk Y, Knight R, Burrows L. Should pediatric donors younger than 2 years of age be used in kidney transplantation? Transplant. Proc. 1997; 29: 3276–3277.

    Article  PubMed  CAS  Google Scholar 

  3. Banowsky LH, Lackner J, Kothmann R, Wright F. Results of single kidneys from donors aged 9 to 60 months: results in 144 adult recipients. Transplant. Proc. 1997; 29: 3271–3273.

    Article  PubMed  CAS  Google Scholar 

  4. Abdi R, Slakey D, Kittur D, Burkick J, Racusen L. Baseline glomerular size as a predictor of function in human renal transplantation. Transplantation. 1998; 66: 329–333.

    Article  PubMed  CAS  Google Scholar 

  5. Cosyns JP, Malaise J, Hanique G, Mourad M, Baldi A, Goebbels RM, Squifflet JP. Lesions in donor kidneys: nature, incidence, and influence on graft function. Transplant. Int. 1998; 11: 22–27.

    Article  CAS  Google Scholar 

  6. Gaber LW, Moore LW, Alloway RR, Amiri MH, Vera SR, Gaber AO. Glomerulosclerosis as a determinant of posttransplant function of older donor renal allografts. Transplantation. 1995; 60: 334–339.

    Article  PubMed  CAS  Google Scholar 

  7. Higgins RM, Sheriff R, Bittar AA, Richardson AJ, Ratcliffe PJ, Gray DWR, Morris PJ. The quality of function of renal allografts is associated with donor age. Transplant. Int. 1995; 8: 221–225.

    Article  CAS  Google Scholar 

  8. Terasaki PI, Gjertson DW, Cecka JM, Takemoto S, Cho YW. Significance of the donor age effect on kidney transplants. Clin. Transplant. 1997; 11: 366–372.

    PubMed  CAS  Google Scholar 

  9. Abonna GM. Marginal donors: a viable solution for organ shortage. Transplant. Proc. 1997; 29: 2759–2764.

    Article  Google Scholar 

  10. Anil Kumar MS, Panigrahi D, Dezii CM et al. Long-term function and survival of elderly donor kidneys transplanted into young adults. Transplantation. 1998; 65: 282–285.

    Article  PubMed  CAS  Google Scholar 

  11. Sola R, Guirado LL, Lopez Navidad A et al. Renal transplantation with limit donors. Transplantation. 1998; 66: 1159–1163.

    Article  PubMed  CAS  Google Scholar 

  12. Connolly JK, Dyer PA, Martin S, Parrott NR, Pearson RC, Johnson RWG. Importance of minimizing HLA-DR mismatch and cold preservation time in cadaveric renal transplantation. Transplantation. 1996; 61: 709–714.

    Article  PubMed  CAS  Google Scholar 

  13. Robertson AJ, Morris PJ. Do re-grafts require more aggressive immunosuppression? Transplant. Clin. Immunol. 1997; 29: 109–119.

    Article  Google Scholar 

  14. Neugarten J, Srinivas T, Tellis V, Silbiger S, Greenstein S. The effect of donor gender on renal allograft survival. J. Am. Soc. Nephrol. 1996; 7: 318–324.

    PubMed  CAS  Google Scholar 

  15. Miles AMV, Sumrani N, John S et al. The effect of kidney size on cadaveric renal allograft outcome. Transplantation. 1996; 61: 894–897.

    Article  PubMed  CAS  Google Scholar 

  16. Mirsch JD, Miller J, Deierhoi MH, Vincenti F, Filo RS for the FK506 kidney transplant study group. A comparison of tacrolimus (FK506) and cyclosporine for immunosuppression after cadaveric renal transplantation. Transplantation. 1997; 63: 977–83.

    Article  Google Scholar 

  17. Mayer AD, Dmitrewski J, Squifflet JP et al. Multicenter randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection. A report of the European tacrolimus multicenter renal study group. Transplantation. 1997; 64: 436–443.

    Article  PubMed  CAS  Google Scholar 

  18. Sollinger HN. Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. Transplantation. 1995; 60: 225–232.

    Article  PubMed  CAS  Google Scholar 

  19. Halloran P, Mathew T, Tomlanovich S, Groth C, Hooftman L, Barker C for the international mycophenolate mofetil renal transplant study group. Mycophenolate mofetil in allograft recipients. Transplantation. 1997; 63: 39–47.

    Article  PubMed  CAS  Google Scholar 

  20. Gulanickar AC, McDonald AC. Sungertekin U, Belitsky P. The incidence and impact of early rejection episodes on graft outcome in recipients of first cadaver kidney transplants. Transplantation. 1992; 53: 323.

    Article  Google Scholar 

  21. Pfaff WW, Howard RJ, Patton PR, Adams VR, Rosen CB, Reed AI. Delayed graft function after renal transplantation. Transplantation. 1998; 65: 219–223.

    Article  PubMed  CAS  Google Scholar 

  22. Cosio FG, Pelletier RP, Falkenhain ME et al. Impact of acute rejection and early allograft function on renal allograft survival. Transplantation. 1997; 63: 1611–1615.

    Article  PubMed  CAS  Google Scholar 

  23. Solez K. Axelsen RA, Benekiktsson H et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int. 1993; 44: 411–422.

    Article  PubMed  CAS  Google Scholar 

  24. Newstead CG. Assessment of risk of cancer renal transplantation. Lancet. 1998; 351: 610–611.

    Article  PubMed  CAS  Google Scholar 

  25. Dantal J, Hourmant M, Cantarovitch D, Giral M, Blancho G, Dreno B, Soulillou JP. Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: randomised comparison of two cyclosporin regimens. Lancet. 1998; 351: 623–628.

    Article  PubMed  CAS  Google Scholar 

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Authors

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P. Cochat J. Traeger C. Merieux M. Derchavane

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© 1999 Springer Science+Business Media Dordrecht

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Revillard, J.P., Pouteil-Noble, C., Cochat, P. (1999). Questions raised by the exclusion of ‘at risk’ conditions from current trials in organ transplantation. In: Cochat, P., Traeger, J., Merieux, C., Derchavane, M. (eds) Immunosuppression under Trial. Transplantation and Clinical Immunology, vol 31. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4643-2_20

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  • DOI: https://doi.org/10.1007/978-94-011-4643-2_20

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-5960-2

  • Online ISBN: 978-94-011-4643-2

  • eBook Packages: Springer Book Archive

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