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  • Steven Skipper posted an update 5 months, 1 week ago

    25.8% in 2008, p?<?0.001). As a consequence, a steady and statistically significant (p?<?0.001) increase in the mean eGFR at conversion was observed from 2000 to 2008 (27.1?��?17.2 vs. 50.5?��?35.8?mL/min, Fig.?1C). Along with the increase in eGFR, the percentage of patients being converted with an eGFR <30?mL/min (37.6%) decreased from 2001 (11.1%) to 2008 (0.8%). Furthermore, as expected, patients with an eGFR 500?mg/L at conversion was more frequently observed in the early study years (26.1% in 2000 vs. 13.7% in 2008, p?<?0.001) than in later years. Other notable changes over the study period included the immunosuppressive therapy before conversion: The use find more of depleting antibodies showed a decreasing tendency (25.9% in 2000 vs. 10.0% in 2008, p?=?0.088), while IL-2 receptor antibodies were used increasingly for the later cohorts (11.1% in 2000 vs. 46.7% in 2008, p?<?0.001). The use of CNIs showed a trend toward an increasing use of tacrolimus (37% in 2000 vs. 46.7% in 2008, p?=?0.067) and rather stable use of cyclosporine (59.3% in 2000 vs. 53.3% in 2008, p?=?0.79). Azathioprine (40.7% in 2000 vs. 20% in 2008, p?<?0.001) was largely replaced by mycophenolic acid (40.7% in 2000 vs. 63.3% in 2008, p?<?0.001) toward the final years of the study. The initial and maintenance dose of sirolimus fell from 12.9?��?4.1?mg/d (range 3�C15?mg/d) and 4.7?��?1.8?mg/d in 2000 to 2.7?��?1.2?mg/d (range 1�C5?mg/d) and 1.9?��?0.7?mg/d in 2008 (p?<?0.001 each), respectively. The sirolimus trough levels at six months decreased significantly from 10.6?��?5.0?ng/mL in 2000 to 5.8?��?2.7?ng/mL in 2008 (p?<?0.001). There were no significant changes during the study period regarding sex ratio, type of donation, number of transplant, combined transplantation, HLA mismatches, BPAR, delayed graft function, panel-reactive antibody level >10%, time from transplantation to conversion, time on dialysis, use of ACE/ARB agents before and after conversion, or underlying renal disease. Overall patient survival was 79.9%, and graft survival rates were 67.2% and 59.4% excluding and including death after five yr, respectively. There were 528 patients with data on proteinuria at the time of conversion (311 patients with urinary protein concentration and 217 dipsticks). In 110 patients (20.8%), proteinuria >500?mg/L was detected at conversion (65 patients with urinary protein concentration and 45 dipsticks). First we looked whether proteinuria >500?mg/L at conversion had a negative impact on patient, graft, and overall survival. The five-yr patient survival was 85.8% vs. 59.9% (p?<?0.001). The five-yr death-censored graft survival was 76.6% vs. 31.7% (p?<?0.001), and five-yr overall survival (including death) was 68.5% vs. 21.8% (p?<?0.001).