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Publications (4)12.92 Total impact

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    ABSTRACT: Kidneys from expanded-criteria donors may be particularly susceptible to calcineurin inhibitor (CI)-mediated vasoconstriction and nephrotoxicity. In the early post-transplant phase, using CI may prolong ischemic injury and, in the long term, chronic CI nephrotoxicity is an even greater concern. To avoid the acute and chronic consequences of CI in kidneys from marginal donors, CI-free protocols have been introduced for maintenance immunosuppressive therapy. A CI-free protocol of anti-thymocyte globulin (ATG) induction, sirolimus, mycophenolate mofetil (MMF) and steroids has been adopted at our center in recipients of dual kidney transplantation (DKT) from elderly donors (EDs). Dual kidney transplantations performed since April 2003 on CI-free immunosuppression (group 1 = 31) were compared with earlier DKTs in recipients treated with CI-based therapy (group 2 = 25), retrospectively analyzing patient and graft survival, surgical and medical complications, rejection episodes and renal function. No deaths occurred after a mean follow-up of 10.1 +/- 7.6 (group 1) and 48.2 +/- 17.4 months (group 2). Graft loss occurred in one patient in group 1 (bilateral renal vein thrombosis) and in three patients in group 2 (one primary non-function [PNF], one chronic rejection, one Kaposi's sarcoma). The incidence of acute rejection was 19% in group 1 and 16% in group 2. Delayed graft function (DGF) was recorded in 16% and 48%, respectively. Renal function was better in group 1, with a mean S-Cr of 135 +/- 48 vs. 210 +/- 141 micromol/L at one month and 116 +/- 30 vs. 149 +/- 49 micromol/L at six months. After DKT from EDs, a CI-free immunosuppressive regimen including ATG induction, sirolimus, MMF and steroids affords excellent results, with a lower DGF rate and a better renal function.
    Clinical Transplantation 01/2007; 21(1):57-62. · 1.63 Impact Factor
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    ABSTRACT: A combination of tacrolimus (TAC) and sirolimus (SIR) has recently proved to be a very effective immunosuppressive regimen in organ transplantation. In pediatric transplant recipients, co-administration of these two drugs has been shown to result in a significant decrease of exposure to TAC, whereas conflicting data have been obtained regarding this pharmacokinetic interaction in adults. The aim of this study was to investigate the effect of SIR on TAC pharmacokinetics in adult transplant recipients. Sixteen adult patients (mean age 38+/-8 years), who had been on standard TAC plus low-dose SIR immunosuppressive treatment for 6 months after renal transplantation, were enrolled for a TAC pharmacokinetic study before and 15 days after discontinuing SIR. Eight patients had received SIR 0.5 mg day(-1) and eight patients 2 mg day(-1). TAC doses remained the same in all patients after SIR withdrawal. After discontinuing SIR, statistically significant, dose-dependent increases were observed in area under the curve (AUC), peak (C(max)) and trough (C(min)) TAC concentrations (+15-20% and +27-32%, after discontinuing the 0.5 and the 2 mg day(-1) doses, respectively). Proportional decreases were consistently observed in apparent oral clearance (-13% and -23%). Very good correlations were found between TAC AUC and C(min), both before and after SIR withdrawal (R(2)=0.94, P<0.0001 and R(2)=0.97, P<0.0001, respectively). Our findings clearly demonstrate that the SIR-induced reduction in TAC exposure also takes place in adults and is, therefore, a general, age-independent phenomenon. Hence, TAC levels need to be carefully monitored in transplant recipients of any age, in order to avoid possible TAC overexposure upon SIR discontinuation.
    Pharmacological Research 09/2006; 54(3):181-5. · 4.35 Impact Factor
  • Transplantation 07/2006; 82(1):142. · 3.78 Impact Factor
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    ABSTRACT: Dual kidney transplantation (DKT) from marginal donors is increasingly used at many centers to help cope with the organ shortage problem. The disadvantages of DKT consist in longer operating times and the risk of surgical complications. DKT can be performed in two ways, i.e. using monolateral or bilateral procedures. From October 1999 to June 2005, 58 DKTs were performed at our unit. In 29 cases (group I), the kidneys were extraperitoneally placed bilaterally in the iliac fossae via two separate incisions; as of June 2003, monolateral kidney placement was preferred in 29 cases, whenever compatible with the recipient's morphological status (group II). After a mean follow-up of 51 +/- 19 months for group I and 15 +/- 7 months for group II, all patients are alive with 1-year graft survival rates of 93% and 96%, respectively. Mean operating times were 351 +/- 76 min in group I and 261 +/- 31 min in group II (P = 0.0001). The mean S-creatinine levels in groups I and II were 132 +/- 47 and 119 +/- 36 mumol/l, respectively, at 1 year. We observed eight surgical complications in group I and seven in group II. Both techniques proved safe, with no differences in surgical complication rates. The monolateral procedure has the advantage of a shorter operating time and the contralateral iliac fossa remains available for further retransplantation procedures.
    Transplant International 07/2006; 19(6):485-91. · 3.16 Impact Factor