***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Acute and chronic lesion scores on renal allograft protocol biopsies may predict long-term graft function . The aim of this study was to compare the effects of tacrolimus ( Tac ) and cyclosporine microemulsion ( CsA ) based immunosuppressive protocol s using protocol biopsies from well-functioning renal allografts . 35 consecutive renal transplant patients were r and omized to Tac ( n : 17 ) versus CsA ( n : 18 ) treatment arms . Patient age and sex , donor type and age , histocompatibility , cold ischemia time and prior delayed graft function were similar between the two groups . Treatment protocol consisted of prednisolone , azathioprine and Tac or CsA. Biopsies performed on the third , sixth and twelfth months were blindly evaluated by the same pathologist . The incidences of acute rejection ( AR ) episodes among CsA vs Tac groups were 33 % vs 29 % , respectively ( NS ) . The Creatinine level was lower in Tac than CsA , although it was not significant ( Table ) . Sub clinical AR and sub clinical chronic allograft nephropathy were detected on protocol biopsies in 3 ( 2 CsA , 1 Tac ) and 12 ( 7 CsA , 5 Tac ) patients , respectively . Acute lesion score at the third month PBx was significantly lower in the Tac group ( p < 0.05 ) . Chronic lesion scores in all biopsies were lower in the Tac group , although not significantly . The protocol biopsy findings suggest that graft injury may be less pronounced among the Tac group Abstract : Background : Balancing the risk of acute rejection ( AR ) with drug‐induced toxicities complicates the selection of the optimal immunosuppressive regimen , especially in the high‐risk renal transplant recipient . This study was design ed to determine the optimal dosage combinations of tacrolimus and sirolimus in a high‐risk cadaveric renal transplant population BACKGROUND The addition of induction therapy with antilymphocytic antibodies to cyclosporine ( CsA ) based immunosuppression , has reduced acute rejection incidence and improved short-term survivals , but has not had well-established effects on long-term renal transplant survival . PATIENTS We analyzed the long-term allograft outcome of patients included in a prospect i ve r and omized clinical study conducted in our center 15 years ago by comparing two strategies : ( A ) horse antilymphoblast globulin ( ALG ) given at 10 mg/kg on alternate days to a maximum of 6 doses with low-dose CsA started at 8 mg/kg per day and prednisone at 0.25 mg/kg per day , versus ( B ) CsA started at 15 mg/kg per day and prednisone at 0.5 mg/kg per day . Diabetic and highly sensitized patients ( PRA > 70 % ) were excluded from the study . RESULTS The characteristics of the 50 patients enrolled in each group were not different . Although patient survival was not different ( 88 % in group A vs 77 % in group B ) , recipients treated with ALG showed a lower incidence of acute rejection episodes ( 20 % vs 44 % , P = .01 ) and better death-censored renal allograft survival ( 57 % vs 41 % , P = .03 ) . Among rejection-free patients , graft survival was 15 % higher in group A ( 60 % vs 45 % , P = .12 ) . Multivariate Cox regression analysis showed that an acute rejection episode ( relative risk [ RR ] : 2.44 , 95 % confidence interval [ CI ] 1.36 - 4.39 ; P = .0029 ) rather than ALG immunosuppression ( RR 0.74 , 95 % CI 0.41 - 1.33 ; P = NS ) was an independent predictor of death-censored graft survival . CONCLUSIONS In summary , we confirmed that concomitant induction therapy with ALG , CsA , and steroids improves long-term renal allograft survival Abstract Objective To examine the extent and nature of outcome reporting bias in a broad cohort of published r and omised trials . Design Retrospective review of publications and follow up survey of authors . Cohort All journal articles of r and omised trials indexed in PubMed whose primary publication appeared in December 2000 . Main outcome measures Prevalence of incompletely reported outcomes per trial ; reasons for not reporting outcomes ; association between completeness of reporting and statistical significance . Results 519 trials with 553 publications and 10 557 outcomes were identified . Survey responders ( response rate 69 % ) provided information on unreported outcomes but were often unreliable — for 32 % of those who denied the existence of such outcomes there was evidence to the contrary in their publications . On average , over 20 % of the outcomes measured in a parallel group trial were incompletely reported . Within a trial , such outcomes had a higher odds of being statistically non-significant compared with fully reported outcomes ( odds ratio 2.0 ( 95 % confidence interval 1.6 to 2.7 ) for efficacy outcomes ; 1.9 ( 1.1 to 3.5 ) for harm outcomes ) . The most commonly reported reasons for omitting efficacy outcomes included space constraints , lack of clinical importance , and lack of statistical significance . Conclusions Incomplete reporting of outcomes within published articles of r and omised trials is common and is associated with statistical non- significance . The medical literature therefore represents a selective and biased subset of study outcomes , and trial protocol s should be made publicly available Background . FTY720 is the first of a new drug class : sphingosine-1-phosphate receptor agonist . Its effect relates to the modulation of lymphocytes trafficking from blood and peripheral tissues to lymph nodes . This is the first study to evaluate the efficacy and safety of FTY720 in de novo renal transplantation . Methods . This phase 2a , multicenter , open-label , dose-finding study compared FTY720 ( 0.25 , 0.5 , 1.0 , or 2.5 mg ) with mycophenolate mofetil ( MMF ) , in combination with cyclosporine and corticosteroids .  Patients ( n=208 ) received FTY720  ( n=167 ) or MMF ( n=41 ) for 3 months followed by a 3-month follow-up . Results . The incidence of biopsy-confirmed acute rejection at month 3 was 23.3 % , 34.9 % , 17.5 % , and 9.8 % , respectively , with FTY720 at doses of 0.25 , 0.5 , 1.0 , and 2.5 mg , versus 17.1 % with MMF . The incidence for the composite endpoint ( biopsy-confirmed acute rejection , graft loss , or death ) was lowest with FTY720 at a dose of 2.5 mg at month 3 ( 14.6 % ) compared with FTY720 at doses of 0.25 mg ( 25.6 % ) , 0.5 mg ( 34.9 % ) , and 1.0 mg ( 17.5 % ) , and MMF ( 19.5 % ) . Safety was comparable between FTY720 and MMF group . The main difference in tolerability was a mild and transient reduction in heart rate . A decrease in peripheral lymphocytes occurred in patients receiving FTY720 , as expected from the mode of action , and this was reversible after treatment cessation . Conclusions . FTY720 at 2.5 mg was found to be as effective as MMF in combination with cyclosporine for the prevention of acute rejection after renal transplantation . FTY720 was well tolerated and not associated with the side effects commonly observed with immunosuppressant therapies Background . Hypertension is common after liver transplantation . There are few published data on optimum treatment . Augmentation index ( AIx ) is a measure of arterial wave reflection determined by pulse wave analysis . Methods . Amlodipine was administered to 24 hypertensive liver transplant recipients . Thirteen patients intolerant of or unresponsive to amlodipine  were r and omized to a crossover study comparing bisoprolol with lisinopril . Results . With amlodipine  , systolic blood pressure ( SBP ) fell from 154±2 mm Hg to 130±2 mm Hg , and AIx also fell . With bisoprolol  , SBP fell from 154±2 mm Hg to 142±4 mm Hg , but AIx increased . With lisinopril  , SBP fell from 154±2 mm Hg to 130±5 mm Hg , and AIx also fell ( P < 0.001 throughout ) . Conclusions . Amlodipine is an effective treatment for hypertension . The increased AIx with bisoprolol indicates increased wave reflection such that central aortic pressure is reduced less than peripheral SBP  . Lisinopril reduces AIx and reduces SBP more than bisoprolol and is the preferred drug AIM Organ shortage is a rate-limiting factor for transplantation . The aim of this study was to evaluate the impact of an educational program targeted to high school students on opinions concerning organ donation . METHODS Sixteen public high schools in Torino , Italy , were r and omized ( 2001 to 2002 ) as interventions ( n = 8) or  controls ( n = 8) . Intervention was composed of first question naire , first lesson ( one to two classes ; 2 hours , by a trained nephrology fellow ) ; second lesson ( all classes together ; coordinated by a nephrologist , with patients and trainees ) ; second question naire . Control included question naires . Statistical analysis compared the opinions in the question naires after stratification for age , sex , and type of school . RESULTS Fourteen schools completed the program ( seven interventions : 937 first and 808 second question naires ; controls : 739 and 659 ) . Television ( 82.5 % ) and newspapers ( 43.2 % ) were the main sources of information ; knowledge on renal transplantation ( grafts feasible per patient , average duration ) was low ; only 12.2 % of the students gave correct answers . The opinions on living donation were highly positive ( 76.8 % ) with no difference in control , intervention schools , first and second question naires , according to sex , age , or type of school . The opinions on cadaveric transplantation were affected by the educational intervention with a drop in negative answers ( from 33.7 % to 16 % ) , with an increase in positive ( from 31.5 % to 42.9 % ) and in uncertain ones ( from 34.8 % to 41.1 % ) among the intervention schools ; 98 % of the students appreciated the program . CONCLUSION The positive effect on student opinions suggests the need to develop educational approaches as a part of our routine clinical work BACKGROUND Since the introduction of calcineurin inhibitors , there has been a significant improvement in the results of solid organ transplantation , including graft and patient survival . However , high cost , chronic nephrotoxicity and other side effects st and as major challenges for long-term use of these drugs . The long-term safety and financial benefits of the combination ketoconazole-cyclosporine previously studied . However , data about the effect of the addition of ketoconazole addition to tacrolimus-treated patients are scarce . Therefore , this study was conducted to evaluate the safety and financial impact of that combination . METHODS The subjects of this work included 70 live-donor stable kidney transplant recipients receiving tacrolimus . Their age ranged from 16 to 45 years . Among them , 54 were males and 16 were females . All of them were 6 months or more post-transplantation . Patients were r and omly divided into two equal groups . Group I patients initially received ketoconazole 100 mg/day in addition to their usual treatment , while group II patients were considered a control . Patients were followed-up for 6 months . RESULTS Concomitant ketoconazole-tacrolimus result ed in marked reduction of  tacrolimus dose ( by 58.7 % ) and cost ( by 56.9 % ) . It also result ed in significant improvement in graft function and fungal skin infection , in addition to a decrease of gastrointestinal episodes and hospitalization . CONCLUSION We conclude that ketoconazole-tacrolimus combination in kidney transplant recipients is safe , has outst and ing impact on treatment costs and improves patient and graft outcome BACKGROUND Bone loss occurs during the first 6 months after renal transplantation ( RT ) , and corticosteroid therapy plays an important role . Although calcium plus vitamin D administration prevents corticosteroid-induced osteoporosis , its use in RT recipients is limited by the risk of hypercalcemia . METHODS This double-blind , r and omized , and controlled prospect i ve intervention trial examined the effect of intermittent calcitriol ( 0.5 microg/48 h ) during the first 3 months after RT , plus oral calcium supplementation ( 0.5 g/day ) during 1 year with calcium supplementation alone . The primary outcome measure was the change in bone mineral density ( BMD ) at 3 and 12 months after RT ; we also explored whether the effect of calcitriol on BMD was different among vitamin D receptor ( VDR ) genotypes ( BsmI ) . Forty-five recipients were r and omized to calcitriol therapy ( CT ) and 41 were r and omized to placebo ( PL ) . RESULTS Both groups had a similar degree of pre-existing hyperpar 
    Output:
    
Recently Fritsche et al. ( 2 ) have review ed 63 reports of large multicenter trials of immunosuppression in transplantation published since 1990 and have found serious defects in study quality and the quality of outcome reporting .