title: Calcineurin inhibitor-free immunosuppression in dual kidney transplantation from elderly donors.
abstract: BACKGROUND
  Kidneys from expanded-criteria donors may be particularly susceptible to calcineurin inhibitor (CI)-mediated vasoconstriction and nephrotoxicity. In the early post-transplant phase, using CI may prolong ischemic injury and, in the long term, chronic CI nephrotoxicity is an even greater concern. To avoid the acute and chronic consequences of CI in kidneys from marginal donors, CI-free protocols have been introduced for maintenance immunosuppressive therapy. A CI-free protocol of anti-thymocyte globulin (ATG) induction, sirolimus, mycophenolate mofetil (MMF) and steroids has been adopted at our center in recipients of dual kidney transplantation (DKT) from elderly donors (EDs).
  
  
  METHODS
  Dual kidney transplantations performed since April 2003 on CI-free immunosuppression (group 1 = 31) were compared with earlier DKTs in recipients treated with CI-based therapy (group 2 = 25), retrospectively analyzing patient and graft survival, surgical and medical complications, rejection episodes and renal function.
  
  
  RESULTS
  No deaths occurred after a mean follow-up of 10.1 +/- 7.6 (group 1) and 48.2 +/- 17.4 months (group 2). Graft loss occurred in one patient in group 1 (bilateral renal vein thrombosis) and in three patients in group 2 (one primary non-function [PNF], one chronic rejection, one Kaposi's sarcoma). The incidence of acute rejection was 19% in group 1 and 16% in group 2. Delayed graft function (DGF) was recorded in 16% and 48%, respectively. Renal function was better in group 1, with a mean S-Cr of 135 +/- 48 vs. 210 +/- 141 micromol/L at one month and 116 +/- 30 vs. 149 +/- 49 micromol/L at six months.
  
  
  CONCLUSIONS
  After DKT from EDs, a CI-free immunosuppressive regimen including ATG induction, sirolimus, MMF and steroids affords excellent results, with a lower DGF rate and a better renal function.
authors.affiliation: Operative Unit of Kidney and Pancreas Transplantation, Padova University Hospital, Padova, Italy. lucrezia.furian@unipd.it
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Furian
authors.forename: Nicola
authors.initials: N
authors.lastname: Baldan
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Margani
authors.forename: Burcin
authors.initials: B
authors.lastname: Ekser
authors.forename: Cristina
authors.initials: C
authors.lastname: Silvestre
authors.forename: Francesco
authors.initials: F
authors.lastname: Marchini
authors.forename: Luciana
authors.initials: L
authors.lastname: Bonfante
authors.forename: Barbara
authors.initials: B
authors.lastname: Rossi
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Valente
authors.forename: Paolo
authors.initials: P
authors.lastname: Rigotti
mesh_terms: D000368:Aged; D019703:Calcineurin / Q000009:adverse effects*; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods / Q000401:mortality; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D017582:Renal Replacement Therapy; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014511:Uremia
chemical_list: D007166:Immunosuppressive Agents; D019703:Calcineurin; D009173:Mycophenolic Acid