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  • Steven Skipper posted an update 7 months, 1 week ago

    76?mL/min/1.73?m2 (p?=?0.035). Decrease in serum PTH was accompanied by a decrease in eGFR (p?=?0.0127) in the first two?months post-parathyroidectomy. Patients whose eGFR declined by ��20% (group 1) in the first two?months post-parathyroidectomy were distinguished from the patients whose eGFR declined by <20% (group 2). The two groups were similar except that group 1 had a higher baseline mean serum PTH compared with group 2, although not significant (1046.7?��?1034.2 vs. 476.6?��?444.9, p?=?0.14). In group 1, eGFR declined at an average rate of 32% (p?<?0.0001) during the first month post-parathyroidectomy find more compared with 7% (p?=?0.1399) in group 2, and the difference between these two groups was significant (p?=?0.0003). The graft function recovered in both groups by one?yr. During median follow-up of 66.00?��?49.45?months, 6 (18%) patients lost their graft with a mean time to graft loss from parathyroidectomy of 37.2?��?21.6?months. The causes of graft loss were rejection (n?=?2), pyelonephritis (n?=?1) and chronic allograft nephropathy (n?=?3). No graft loss occurred during the first-year post-surgery. Parathyroidectomy may lead to transient kidney allograft dysfunction with eventual recovery of graft function by 12?months post-parathyroidectomy. Higher level of serum PTH pre-parathyoidectomy is associated with a more profound decrease in eGFR post-parathyroidectomy. ””Kriss M, Sotil EU, Abecassis M, Welti M, Levitsky J. Mycophenolate mofetil monotherapy in liver transplant recipients. Clin Transplant 2011: 25: E639�CE646. ? 2011 John Wiley & Sons A/S. Abstract:? Introduction:? Complete conversion of calcineurin inhibitor (CNI) immunosuppressant therapy to non-nephrotoxic agents such as mycophenolate mofetil (MMF) is controversial, but may be safe in selected patients, although appropriate protocols and long-term benefits of conversion are not well reported. Methods:? We analyzed all liver transplant (LT) recipients at our institution who were converted from CNI-based therapy to MMF monotherapy because of renal dysfunction (n?=?23) and compared them with patients remaining on CNI-based therapy (n?=?23). Renal function, rejection episodes, and markers of CNI-related comorbidities (lipid profile, blood pressure, and glycosylated hemoglobin) were noted. Results:? Overall, serum creatinine (SCr) and calculated glomerular filtration rate improved on MMF monotherapy. This improvement was significant when compared with patients who remained on CNI-based therapy. Improvement was most pronounced in patients with milder renal dysfunction (SCr <2.2?mg/dL prior to conversion) (n?=?14) with decrease in SCr from 1.63?��?0.29 to 1.34?��?0.26?mg/dL (p?=?0.02) at last follow-up. Five patients on MMF monotherapy (21.7%) progressed to end-stage renal disease (ESRD), while only two (8.7%) had rejection episodes following conversion. Clinical markers of CNI-related comorbidities also improved.