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Calcineurin Inhibitor Sparing Using Mycophenolate May Play a Key Role in Kidney Transplantation: Presented at ASN

By Maggie Schwarz

PHILADELPHIA -- November 9, 2008 -- Adjunctive mycophenolate used in a calcineurin inhibitor-sparing strategy may play an important role in kidney transplant recipients, according to research presented at Renal Week 2008, the American Society of Nephrology (ASN) annual meeting.

Coinvestigator Keith Wheatley, MD, University of Birmingham, Birmingham, United Kingdom, was part of a team that performed a systematic review and meta-analysis of 19 randomized controlled trials in which calcineurin inhibitor sparing was accompanied by continuation of mycophenolate or conversion to this agent and compared with standard or higher-dose calcineurin inhibitor therapy. Dr. Wheatley reported the results here at a poster presentation on November 8.

The trials analyzed included 3,312 renal transplant recipients who were followed for a median of 12 months. The following subgroups were studied: elective calcineurin inhibitor sparing beyond 2 months after transplantation; calcineurin inhibitor sparing for transplant dysfunction; and de novo calcineurin inhibitor sparing.

Calcineurin inhibitor sparing improved glomerular filtration rate significantly (weighted mean difference of 4.4 mL/min, P < .001), with evidence of improved graft survival (P = .06). Acute rejection rates were increased only following elective calcineurin inhibitor elimination (P < .001).

There were no significant differences in mortality, malignancy, or incidence of infections.

Dr. Wheatley concluded that calcineurin inhibitor-sparing strategies using adjunctive mycophenolate may play an important role in kidney transplant recipients, such as offering improvements in short-term graft function and possibly graft survival. He added that refinement of protocols for the elimination of calcineurin inhibitor may help to reduce the risk of rejection.

[Presentation title: Kidney Transplantation and Calcineurin Inhibitor Sparing With Adjunctive Mycophenolate: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Abstract SA-PO2551]

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