Efficacy and safety of early cyclosporine conversion to sirolimus with continued MMF-four-year results of the Postconcept study.

Yvon Lebranchu 1 A. Thierry 2 Etienne Thervet 3 M. Büchler 1 I. Etienne 4 P. F. Westeel 5 B. Hurault de Ligny 6 B. Moulin 7 Jean-Philippe Rerolle 8 T. Frouget 9 S. Girardot-Seguin 10 Olivier Toupance 11
1 Service de néphrologie et immunologie clinique
2 Service de néphrologie - hémodialyse et transplantation rénale
3 Service de néphrologie adultes [CHU Necker]
4 Service de Néphrologie [Rouen]
5 Service de dyalise et transplantation
6 service de néphrologie et transplantation rénale
7 service de néphrologie et transplantation
8 Service de Néphrologie, Dialyse, Transplantations [CHU Limoges]
9 Service de néphrologie
10 Roche SAS
11 service de néphrologie et transplantation
Abstract : Calcineurin inhibitor (CNI) withdrawal has been used as a strategy to improve renal allograft function. We previously reported that conversion from cyclosporine A (CsA) to sirolimus (SRL) 3 months after transplantation significantly improved renal function at 1 year. In the Postconcept trial, 77 patients in the SRL group and 85 in the CsA group were followed for 48 months. Renal function (Cockcroft and Gault) was significantly better at month 48 (M48) in the SRL group both in the intent-to-treat population (ITT): 62.6 mL/min/1.73 m(2) versus 57.1 mL/min/1.73 m(2) (p = 0.013) and in the on-treatment population (OT): 67.5 mL/min/1.73 m(2) versus 57.4 mL/min/1.73 m(2) (p = 0.002). Two biopsy proven acute rejection episodes occurred after M12 in each group. Graft and patient survival were comparable (graft survival: 97.4 vs. 100%; patient survival: 97.4 vs. 97.6%, respectively). The incidence of new-onset diabetes was numerically increased in the SRL group (7 vs. 2). In OT, three cancers occurred in the SRL group versus nine in the CsA group and mean proteinuria was increased in the SRL group (0.42 ± 0.44 vs. 0.26 ± 0.37; p = 0.018). In summary, the renal benefits associated with conversion of CsA to SRL, at 3 months posttransplantation, in combination with MMF were maintained for 4 years posttransplantation.
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American Journal of Transplantation, Wiley, 2011, 11 (8), pp.1665-75. 〈10.1111/j.1600-6143.2011.03637.x〉
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http://www.hal.inserm.fr/inserm-00926380
Contributeur : Pierre Marquet <>
Soumis le : jeudi 9 janvier 2014 - 15:04:35
Dernière modification le : jeudi 6 septembre 2018 - 01:17:29

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UNIV-PARIS5 | UNIV-POITIERS | USPC | UNIV-RENNES | COMUE-NORMANDIE | UNIROUEN

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Yvon Lebranchu, A. Thierry, Etienne Thervet, M. Büchler, I. Etienne, et al.. Efficacy and safety of early cyclosporine conversion to sirolimus with continued MMF-four-year results of the Postconcept study.. American Journal of Transplantation, Wiley, 2011, 11 (8), pp.1665-75. 〈10.1111/j.1600-6143.2011.03637.x〉. 〈inserm-00926380〉

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