title: An open randomized study comparing immunosuppression therapy initiated before or after kidney transplantation in haploidentical living recipients.
abstract: BACKGROUND
  Acute rejection is the most important risk factor for graft survival. Although many centers start immunosuppressive therapy days before the surgery in living donors, there is no systematic study concerning the possible advantages of this procedure. In this open randomized study, we compared the efficacy and safety of administration of cyclosporine (CSA; Neoral) and azathioprine before renal transplantation with the administration of the same schema after transplantation, in HLA haploidentical grafts.
  
  
  METHODS
  Sixty renal transplant recipients of an HLA haploidentical allograft from living donors were randomized in two groups: (A) patients that started immunosuppression 3 d before transplantation (n = 30) and (B) those who started the drug schema on the first day after surgery (n = 30). We analyzed the incidence and severity of acute rejection, graft function and infection during the first 3 months after transplantation.
  
  
  RESULTS
  The group of patients who started immunosuppression before had a mean trough level of CSA (299.70 +/- 154.03 ng/mL) in the expected range for an efficacious prevention of acute rejection at the surgery day. Thirteen patients (43.3%) in each group had acute rejection during the follow up (p = 1.00). Two grafts losses (3.3%) occurred, one in each group. Both groups had similar 3-month rejection-free graft survival (56.7 and 56.3%). The incidence of infection was also statistical comparable between groups A and B (56.7 vs. 46.7, p = 0.430). Graft function was similar in patients from both groups.
  
  
  CONCLUSIONS
  Pre-transplant administration of immunosuppression did not reduce the incidence or severity of acute rejection episodes during the first 3 months of transplantation. Immunosuppressive drugs administered before engraftment did not increase the incidence of graft dysfunction or infection.
authors.affiliation: Division of Nephrology, Universidade Federal de São Paulo, Sao Paulo-SP, Brazil.
authors.forename: Niels Olsen S
authors.initials: NO
authors.lastname: Câmara
authors.forename: Mônica Felizardo L
authors.initials: MF
authors.lastname: Dias
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pacheco-Silva
mesh_terms: D001379:Azathioprine / Q000008:administration & dosage*; D016572:Cyclosporine / Q000008:administration & dosage* / Q000097:blood; D006084:Graft Rejection / Q000517:prevention & control*; D006680:HLA Antigens; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000097:blood; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology; D019520:Living Donors; D011184:Postoperative Period; D013997:Time Factors
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine