Figure 1
August 1, 2005
The new layout for access to graphics on the CTS website has been well accepted. We recorded an increase of 20 % in graphics access. The use of center-specific graphics has increased in parallel. All graphics, including center-specific graphics, have been updated this month and some 200 new graphs were added. Especially of note is the expansion of the heart transplant section. Please contact us if you have suggestions for further improvements.
The steady increase in CTS website use is impressive. There are various methods of illustrating this, none of which is entirely satisfactory. The increase in "hits", shown in Figure 1, gives you an impression of this trend over the last two years.
Figure 1
A fraction of patients are receiving immunosuppression with calcineurin inhibitors in the form of a "preoperative loading dose". We have examined the CTS data with respect to any demonstrable improvement in outcome associated with "preop loading". Because the number of patients receiving FK/tacrolimus preoperatively was relatively small, the analysis was limited to patients receiving cyclosporine.
Figure 2
Figure 2 shows that, regardless of whether cadaveric kidney recipients received cyclosporine combined with MMF or azathioprine, starting the immunosuppressive treatment with cyclosporine prior to transplantation did not result in better outcome as compared with initiation of treatment 1-5 days posttransplant. The survival rate in the preop loading dose group was even slightly lower.
Because induction with anti-T cell antibodies might influence the result, we performed a separate analysis for patients who did not receive any antibody induction. Even in this patient subset, we did not observe an improvement effect of pretransplant immunosuppression (Figure 3).
Figure 3
The corresponding analysis for related donor transplants is shown in Figure 4. It is evident that there was no difference in outcome regardless of whether the patients received cyclosporine prior to surgery or after the transplant operation was completed.
Figure 4
In summary, the CTS data suggest that timing of initiation of cyclosporine treatment either pre- or post-op, does not significantly influence kidney transplant outcome.
Please note that the next shipping date for the DNA and serum studies is approaching. The next date is:
November 21/22, 2005.
Please continue to collect and store DNA and serum samples. If you experience problems with storage space, contact us and we will be happy to accept your samples at an earlier date.
If you have not yet done so, be sure to obtain approval from your local ethics committee for participation in this study. Since only "left over" material from clinical specimens is used, difficulties with approval are not anticipated. Of course, individual patient consent also needs to be obtained. This is normally done at the time of enrollment on the transplant waiting list.
Thank you for your continued support of the international transplant study.
Sincerely yours,