title: Living donor kidney transplantation: impact of differentiated immunosuppressive regimen.
abstract: BACKGROUND
  Recipients of related (R) and unrelated (NR) living donor kidney transplantations (LDKTX) receive immunosuppressive (IS) therapy 5 days in advance in order to achieve low rates of acute rejection episodes. We herein report the different IS regimens for R and NR transplants as well as acute rejection and primary function rates.
  
  
  METHODS
  Ninety-five LDKTX (69% R, 31% NR) were performed with mean cold ischemia time (CIT) of 145 +/- 32 minutes. In R-LDKTX mean age of recipients was 31 +/- 12.5 years. This cohort included 41 men and 25 women whose mean age was 50 +/- 11.1 years. The therapeutic regimen for R-LDKTX included CyA/MMF/prednisone; for NR-LDKTX, FK/MMF/prednisone. Among the recipients of NR grafts the mean recipient age was 51 +/- 8.5 years. This cohort included 23 men and 6 women whose donor mean age was 50 +/- 8.8 years. The mean HLA mismatch among R-LDKTX (2.3) was significantly less than that in the NR-LDKTX cohort (3.51).
  
  
  RESULTS
  At a mean follow-up of 35 months, 94.7% of grafts were functioning. DGF was seen in only one recipient (1%). Three grafts were lost due to acute (R) or chronic (NR) rejection or to multiorgan failures. Two recipients died with functioning grafts. Biopsy-proven rejection episodes were observed in 17.2% of NR-LDKTX and 9% of R-LDKTX. In R-LDKTX 50% of rejection episodes were corticoid-sensitive, while 33% needed ATG, and 16% were treated by a switch to FK. In NR-LDKTX 20% of rejections were corticoid-sensitive, 40% needed ATG, and 40% were treated with rapamycin rescue therapy.
  
  
  CONCLUSIONS
  Although HLA mismatching is significantly different between R- and NR-LDKTX, no difference in outcome was observed, which may be due to the specific therapeutic regimen and short CIT.
authors.affiliation: Department of General Surgery, University of Münster, Münster, Germany. wolterh@uni-muenster.de
authors.forename: H H
authors.initials: HH
authors.lastname: Wolters
authors.forename: St
authors.initials: S
authors.lastname: Heidenreich
authors.forename: C
authors.initials: C
authors.lastname: Dame
authors.forename: J G
authors.initials: JG
authors.lastname: Brockmann
authors.forename: N
authors.initials: N
authors.lastname: Senninger
authors.forename: C F
authors.initials: CF
authors.lastname: Krieglstein
mesh_terms: D004359:Drug Therapy, Combination; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D049669:History, 16th Century; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents