Immunosuppression for dual kidney transplantation with marginal organs: the old is better yet.
Immunosuppressive protocols in dual kidney transplantation (DKT) are based on calcineurin inhibitors (CNI). We wonder whether a CNI-free immunosuppression can improve outcome in older patients receiving a DKT with marginal donor organs. Thirty-six were treated with CsA, MMF and prednisone (CsA group) and 42 with rATG, SRL, MMF and prednisone (SRL group). Incidence of delayed graft function and acute rejection was 44% and 11% in the CsA group, and 40% and 8% in the SRL group. CMV infection incidence was low in both protocols. Three-year patient survival was 89% in the CsA and 76% in the SRL group. One- and 3-year graft survival after censoring for dead with a functioning allograft was 94.2% and 94% in CsA and 95% and 90% in SRL, respectively. Renal function was similar in both groups whereas proteinuria was higher in the SRL group. Uninephrectomy due to graft thrombosis or urinary-related complications was numerically higher in the SRL (21%) than in the CsA group (8%) (p = 0.13) and it was associated with renal failure and proteinuria. In DKT, a new induction immunosuppressive protocol based on rATG, SRL, MMF and prednisone does not offer any advantage in comparison to the old CsA, MMF and prednisone.
Cruzado
J M
JM
Department of Nephrology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga s/n, 08907 I'Hospitalet de Llobregat, Barcelona, Spain.
Bestard
O
O
Riera
L
L
Torras
J
J
Gil-Vernet
S
S
Serón
D
D
Rama
I
I
Moreso
F
F
Martínez-Castelao
A
A
Grinyó
J M
JM
D065095:Calcineurin Inhibitors; D002318:Cardiovascular Diseases / Q000517:prevention & control; D016572:Cyclosporine / Q000627:therapeutic use; D051799:Delayed Graft Function / Q000517:prevention & control; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D011241:Prednisone / Q000627:therapeutic use; D012306:Risk; D016896:Treatment Outcome
D065095:Calcineurin Inhibitors; D016572:Cyclosporine; D009173:Mycophenolic Acid; D011241:Prednisone