title: [The influence of maintenance immunosuppression scheme on D4d urinary excretion in kidney graft recipients].
abstract: BACKGROUND
  The C4d urinary excretion varies according to the risk of graft rejection or progression of chronic allograft nephropathy. The most common maintenance immunosuppression (IS) schemes includes cyclosporine (CSA) ortacrolimus (TAC with azathiopryne (AZA) or mycophenolane mophetil (MMF). The chosen IS may influence on the kidney transplant outcomes and possibly modify C4d urinary secretion. The aim of the study was to assess whether IS scheme may influence on C4d urinary excretion.
  
  
  METHODS
  The study involved 185 patients who underwent kidney allograft transplantation (KTx).The urinary specimens taken from the morning urine portion was assessed by ELISA test for C4d excretion. To increase the objectivity of the assessment all measurements were divided by urinary creatinine excretion (ng/mg Ucr). The study population was grouped according the IS scheme, i.e., CSA+AZA, CSA+MMF and TAC+MMF.
  
  
  RESULTS
  The highest C4d urinary excretion was noticed in patients treated with CSA+AZA--210 +/- 229 ng/ml (5.1 +/- 7.9 ng/mg Ucr) and the lowest in those in whom tacrolimus and mycophenolane mophetil was administered -198?188 ng/ml (4.4 +/- 7.1 ng/mg Ucr). In CSA+MMF group C4d excretion was 207?256 ng/ml (4.7 +/- 7.7 ng/mg Ucr). The statistically significant differences were seen only between CSA+AZA and TAC+MMF groups--ANOVA p<0.05 (p<0.01 for excretion calculated per Ucr).
  
  
  CONCLUSIONS
  C4d urinary excretion in kidney graft recipients depends on immunosuppression scheme and is the lowest in patients treated with tacrolimus and mycophenolane mophetil.
authors.forename: Rafał
authors.initials: R
authors.lastname: Zwiech
mesh_terms: D000328:Adult; D064591:Allografts; D001379:Azathioprine / Q000494:pharmacology; D015935:Complement C4b / Q000652:urine*; D016572:Cyclosporine / Q000494:pharmacology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D010446:Peptide Fragments / Q000652:urine*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine