title: A calcineurin antagonist-free induction/maintenance strategy for immunosuppression in elderly recipients of renal allografts from elderly cadaver donors: long-term results from a prospective single centre trial.
abstract: BACKGROUND
  With the aim to improve the inferior outcomes in elderly recipients of kidneys from elderly cadaver donors, we applied and investigated a therapeutic regimen consisting of calcineurin inhibitor (CNI)-free, mycophenolate mofetil (MMF)-based immunosuppressive (i.s.) induction/maintenance protocol. In this article, we report the long-term results of this clinical trial.
  
  
  METHODS
  A total of 89 recipients (mean age: 63.8 yr) of kidneys from cadaver donors (mean age: 66.8 yr) were consecutively recruited for this 5-yr, prospective, open, single centre, pilot trial. Induction therapy consisted of MMF and steroids in conjunction with a short course (4-10 d) of rabbit antithymocyte globulin (ATG). Maintenance treatment was performed with MMF/steroids or MMF alone under strict therapeutic drug monitoring by aiming target mycophenolic acid (MPA)-trough levels between 2 and 6 mg/mL.
  
  
  RESULTS
  Cumulative 5-year patient and renal allograft survival was 87.69% and 69.81%, respectively. Acute rejection episodes occurred in 23.6% (21 patients). Long-term function of the old renal allografts proved to be satisfactory as reflected by serum creatinine-values of 1.53 mg/dL and urea-values of 57.9 mg/dL at 5 yr.
  
  
  CONCLUSIONS
  Application of a nephrotoxicity- and atherogenicity-free, MMF-based i.s. induction/maintenance protocol in elderly recipient of kidneys from elderly cadaver donors leads to improved long-term outcomes which are comparable with data from young recipients who have received allografts from young cadaver donors.
authors.affiliation: Division of Transplantation Surgery, Medical Center, University of Munich, Munich, Germany. arbogast@gch.med.uni-muenchen.de
authors.forename: Helmut
authors.initials: H
authors.lastname: Arbogast
authors.forename: Henning
authors.initials: H
authors.lastname: Hückelheim
authors.forename: Helmut
authors.initials: H
authors.lastname: Schneeberger
authors.forename: Wolf-D
authors.initials: WD
authors.lastname: Illner
authors.forename: Anwar
authors.initials: A
authors.lastname: Tarabichi
authors.forename: Jan
authors.initials: J
authors.lastname: Fertmann
authors.forename: Cosmas D
authors.initials: CD
authors.lastname: Wimmer
authors.forename: Günter F
authors.initials: GF
authors.lastname: Hillebrand
authors.forename: Nouhad
authors.initials: N
authors.lastname: Mistry-Burchardi
authors.forename: Robert
authors.initials: R
authors.lastname: Thomae
authors.forename: Ali
authors.initials: A
authors.lastname: Acikgöz
authors.forename: Walter
authors.initials: W
authors.lastname: Land
mesh_terms: D000368:Aged; D002102:Cadaver; D065095:Calcineurin Inhibitors; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D014019:Tissue Donors
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid