Our understanding of transplant immunology has advanced from gross allograft rejection to cellular response and to current molecular level. More sensitive assays have been developed to characterize patient sensitizati...Our understanding of transplant immunology has advanced from gross allograft rejection to cellular response and to current molecular level. More sensitive assays have been developed to characterize patient sensitization and to detect pre-existing donor-specific antibodies(DSA) in pre-transplant crossmatch. After a transplant, pre-existing or de novo DSA are increasingly monitored to guide clinical management. Therefore, it is important for clinicians to understand the basic concepts and key components of transplant immunology as well as be familiarized with the modern immunological techniques used in kidney transplantation.展开更多
AIM： To study the long-term outcome of ketoconazole and tacrolimus combination in kidney transplant recipi-ents. METHODS： From 2006 to 2010, ketoconazole was given in 199 patients and was continued for at least 1 y...AIM： To study the long-term outcome of ketoconazole and tacrolimus combination in kidney transplant recipi-ents. METHODS： From 2006 to 2010, ketoconazole was given in 199 patients and was continued for at least 1 year or until graft failure （Group 1）, while 149 patients did not receive any ketoconazole （Group 2）. A combina-tion of tacrolimus, mycophenolate and steroid was used as maintenance therapy. High risk patients received basiliximab induction. RESULTS： Basic demographic data was similar be-tween the 2 groups. The 5-year cumulative incidence of biopsy-confrmed and clinically-treated acute rejection was signifcantly higher in Group 1 than in Group 2 （34% vs 18%, P = 0.01）. The 5-year Kaplan-Meier estimated graft survival （74.3% vs 76.4%, P = 0.58） and patient survival （87.8% vs 87.5%, P = 0.93） were not different between the 2 groups. Multivariable analyses identifed ketoconazole usage as an independent risk of acute rejection （HR = 2.33, 95%CI： 1.33-4.07; P = 0.003） while tacrolimus dose in the 2nd month was protective （HR = 0.89, 95%CI： 0.75-0.96; P = 0.041）. CONCLUSION： Co-administration of ketoconazole and tacrolimus is associated with significantly higher inci-dence of acute rejection in kidney transplant recipients.展开更多
文摘Our understanding of transplant immunology has advanced from gross allograft rejection to cellular response and to current molecular level. More sensitive assays have been developed to characterize patient sensitization and to detect pre-existing donor-specific antibodies(DSA) in pre-transplant crossmatch. After a transplant, pre-existing or de novo DSA are increasingly monitored to guide clinical management. Therefore, it is important for clinicians to understand the basic concepts and key components of transplant immunology as well as be familiarized with the modern immunological techniques used in kidney transplantation.
文摘AIM： To study the long-term outcome of ketoconazole and tacrolimus combination in kidney transplant recipi-ents. METHODS： From 2006 to 2010, ketoconazole was given in 199 patients and was continued for at least 1 year or until graft failure （Group 1）, while 149 patients did not receive any ketoconazole （Group 2）. A combina-tion of tacrolimus, mycophenolate and steroid was used as maintenance therapy. High risk patients received basiliximab induction. RESULTS： Basic demographic data was similar be-tween the 2 groups. The 5-year cumulative incidence of biopsy-confrmed and clinically-treated acute rejection was signifcantly higher in Group 1 than in Group 2 （34% vs 18%, P = 0.01）. The 5-year Kaplan-Meier estimated graft survival （74.3% vs 76.4%, P = 0.58） and patient survival （87.8% vs 87.5%, P = 0.93） were not different between the 2 groups. Multivariable analyses identifed ketoconazole usage as an independent risk of acute rejection （HR = 2.33, 95%CI： 1.33-4.07; P = 0.003） while tacrolimus dose in the 2nd month was protective （HR = 0.89, 95%CI： 0.75-0.96; P = 0.041）. CONCLUSION： Co-administration of ketoconazole and tacrolimus is associated with significantly higher inci-dence of acute rejection in kidney transplant recipients.
