title: Sequential quadruple immunosuppression including sirolimus in extended criteria and nonheartbeating donor kidney transplantation.
abstract: The aim was to evaluate feasibility and safety of calcineurin inhibitor-free immunosuppression in high-risk donor kidney transplantation with sequential sirolimus introduction. Kidney transplant patients (n=76) with a donor aged >60 years, donor with acute renal failure, or a nonheartbeating donor were included. Immunosuppression consisted of antithymocyte globulin or basiliximab, mycophenolate mofetil, prednisone, and sequential introduction of sirolimus. One-year patient survival was 96.2% and 95.8%; graft survival was 94.2% and 91.7%; acute rejection rates were 21.2% and 12.4%; delayed graft function was 21.2% and 66.7%; and creatinine clearance was 58+/-20 mL/min and 56+/-21 mL/min for the brain-dead donor group and the nonheartbeating donor group, respectively. Most adverse events were infections, but also three lymphoceles, three urinary fistulas, three wound seromas. Sequential sirolimus introduction in high-risk donor kidney transplantation was found to lead to good patient and graft survival and incidence of acute rejection and delayed graft function.
authors: Department of Nephrology and Renal Transplantation, Hospital Clínic, Barcelona, Spain.
authors: Fritz
authors: F
authors: Diekmann
authors: Josep M
authors: JM
authors: Campistol
authors: Núria
authors: N
authors: Saval
authors: Alex
authors: A
authors: Gutiérrez-Dalmau
authors: Edgar M
authors: EM
authors: Arellano
authors: Marta
authors: M
authors: Crespo
authors: Esther
authors: E
authors: Rossich
authors: Núria
authors: N
authors: Esforzado
authors: Federico
authors: F
authors: Cofán
authors: María José
authors: MJ
authors: Ricart
authors: José Vicente
authors: JV
authors: Torregrosa
authors: Federico
authors: F
authors: Oppenheimer
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000077552:Basiliximab; D065095:Calcineurin Inhibitors; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000502:physiology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010865:Pilot Projects; D011241:Prednisone / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D051437:Renal Insufficiency; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*
chemical_list: D000911:Antibodies, Monoclonal; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D009173:Mycophenolic Acid; D011241:Prednisone; D020123:Sirolimus