title: The long-term outcome of tacrolimus in cadaveric kidney transplantation from non-heart beating donors.
abstract: Tacrolimus (Tac), developed in 1990, has been applied as an immunosuppressive agent for liver, heart, and kidney transplantation and is known to have more powerful immunosuppressive effects than cyclosporine (CyA). To evaluate the efficacy of Tac in cadaveric kidney transplants from non-heart beating donors, we present the long-term outcome of patients receiving kidneys with ischemic damage, and compared it with that of CyA. Between July 1990 and December 2000, 55 patients with end-stage renal disease received kidneys from non-heart beating donors (Maastrichy category 3) and were treated with Tac and steroid immunosuppressive therapy. During the same period, we also performed 137 non-heart beating cadaveric renal transplants treated with CyA-based immunosuppressive therapy. The patient survival rate was 98% at 1 yr and 96% at 3-10 yr in the Tac group, and 97% at 1-3 yr, 93% at 5 yr and 85% at 10 yr in the CyA group. The graft survival rate was 91% at 1 yr, 80% at 3 yr, 63% at 5 yr and 34% at 10 yr in the Tac group, and 88% at 1 yr, 75% at 3 yr, 63% at 5 yr and 49% at 10 yr in the CyA group. There was no significant difference in either patient or graft survival rates between the two groups. Acute early rejection in the Tac group was less than that in the CyA group but acute tubular necrosis was the same in both groups. This indicates that Tac is available for cadaveric kidney transplants from non-heart beating donors. In conclusion, Tac is available as an immunosuppressive agent even for kidney transplants from non-heart beating donors.
authors.affiliation: Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan. fukuhara@chubu-nh.go.jp
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Fukuhara
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Ono
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hattori
authors.forename: Naoki
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Shin
authors.initials: S
authors.lastname: Yamada
authors.forename: Osamu
authors.initials: O
authors.lastname: Kamihira
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Kinukawa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohshima
mesh_terms: D000328:Adult; D002102:Cadaver; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007511:Ischemia / Q000503:physiopathology; D007668:Kidney / Q000098:blood supply; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000502:physiology; D007683:Kidney Tubular Necrosis, Acute / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D015996:Survival Rate; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus; D008775:Methylprednisolone