title: Exploratory calcineurin inhibitor-free regimens in living-related kidney transplant recipients.
abstract: Chronic allograft nephropathy is among the major causes of graft loss even in low-risk kidney transplant recipients and correlates with acute nephrotoxic events during the first year post-transplant. Therefore, calcineurin inhibitor-free regimens may improve patient and graft survival among recipients of living-related kidney transplants. To confirm this hypothesis, we evaluated the efficacy and safety of two calcineurin inhibitor-free regimens in 92 low-risk recipients of one-haplotype living-related kidney transplants. Immunosuppression consisted of tacrolimus, azathioprine and prednisone (group I, GI, N = 38), 2 doses of daclizumab, mycophenolate mofetil (MMF), and prednisone (GII, N = 33) and 2 doses of daclizumab, MMF, sirolimus and prednisone (GIII, N = 21). At 12 months, treatment failure (biopsy-confirmed acute rejection, graft loss or death) was higher in GII compared to GIII and GI (54.5 vs 24.0 vs 13.1%, P < 0.01, respectively). In patients of black ethnicity the incidence of acute rejection was 25 vs 83.3 vs 20% (P = 0.055), respectively. Patient and graft survival was comparable. There were no differences in mean creatinine or calculated creatinine clearance at 12 months. Overall incidence of post-transplant diabetes mellitus (3.3%) and cytomegalovirus disease (4.3%) was similar in all groups. Further development of effective calcineurin inhibitor-free regimens should exclude patients of black ethnicity and may need full-induction therapy, perhaps with depleting agents, and concentration-controlled use of sirolimus and MMF.
authors.affiliation: Divisão de Nefrologia, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: R
authors.initials: R
authors.lastname: Garcia
authors.forename: P G
authors.initials: PG
authors.lastname: Machado
authors.forename: C R
authors.initials: CR
authors.lastname: Felipe
authors.forename: S I
authors.initials: SI
authors.lastname: Park
authors.forename: G A
authors.initials: GA
authors.lastname: Spinelli
authors.forename: M F
authors.initials: MF
authors.lastname: Franco
authors.forename: H
authors.initials: H
authors.lastname: Tedesco-Silva
authors.forename: J O
authors.initials: JO
authors.lastname: Medina-Pestana
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016030:Kidney Transplantation / Q000276:immunology* / Q000502:physiology; D008297:Male; D011446:Prospective Studies
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents