title: Tacrolimus combined with mycophenolate mofetil can effectively reverse C4d-positive steroid-resistant acute rejection in Chinese renal allograft recipients.
abstract: BACKGROUND
  Tacrolimus (TAC) combined with mycophenolate mofetil (MMF) has been suggested to play a critical role in the reversal of C4d-positive acute humoral rejection (AHR) in renal transplantation, but the efficacy of using only TAC-MMF without immunoadsorption or plasmapheresis has not been investigated. On the other hand, Chinese recipients of renal grafts usually need lower doses of immunosuppressants, and their optimal treatment for acute humoral rejection has not been established.
  
  
  METHODS
  Since 1999, we have used TAC-MMF to treat steroid-resistant acute rejection (AR). C4d staining was retrospectively performed in 32 patients with steroid-resistant AR, and the treatments of 19 patients with C4d-positive steroid-resistant AR were investigated.
  
  
  RESULTS
  Thirteen of 19 patients received TAC-MMF treatment only; 11 episodes of rejection in them were reversed (7 completely, 4 partially) and only 2 recipients lost their graft. Another 6 patients received immunoadsorption also. One of them failed to respond and lost her graft. Four of 5 patients treated with immunoadsorption and TAC-MMF recovered (3 completely, 1 partially), but 3 of them had severe pneumonia, a complication rate statistically higher than in patients treated with only TAC-MMF (P<0.05). AR occurring during the first two weeks after transplantation had a statistically better outcome than that occurring later (P = 0.003).
  
  
  CONCLUSIONS
  Our study suggests that the combination of TAC and MMF is a potentially safe and economic treatment for most Chinese renal allograft recipients with C4d-positive steroid-resistant AR, especially for rejections developing within the first two weeks after transplantation.
authors.affiliation: Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhong Shan Road, Nanjing, 210002, China. sunqiquan@yahoo.com
authors.forename: Qiquan
authors.initials: Q
authors.lastname: Sun
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Liu
authors.forename: Guang
authors.initials: G
authors.lastname: Yin
authors.forename: Huiping
authors.initials: H
authors.lastname: Chen
authors.forename: Jinsong
authors.initials: J
authors.lastname: Chen
authors.forename: Shuming
authors.initials: S
authors.lastname: Ji
authors.forename: Lei-Shi
authors.initials: LS
authors.lastname: Li
mesh_terms: D000208:Acute Disease; D000328:Adult; D015704:CD4 Antigens / Q000276:immunology*; D002681:China; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012074:Remission Induction; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage*
chemical_list: D015704:CD4 Antigens; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone