Preapheresis immunosuppressive induction: necessary or harmful?
In ABO-incompatible kidney transplantation, only a few studies have addressed the necessity, duration, and content of immunosuppressive induction therapy. At our center (Karolinska Institute, Stockholm, Sweden), using a preconditioning regimen consisting of 13 days of tacrolimus, mycophenolate mofetil, and prednisolone, we have investigated both short- and long-term renal allograft function (up to 28 days and 1 year after transplantation, respectively) and correlated them to tacrolimus 12-hr trough levels. In summary, during the first 28 days after transplantation, renal allograft function in the ABO-incompatible group was impaired when compared with that observed in the ABO-compatible group. One possible explanation for this finding is the prolonged pretransplantation exposure to tacrolimus in the ABO-incompatible group, resulting in tacrolimus-associated renal toxicity, which slows the reduction in plasma creatinine. In fact, the day before, and also immediately after, the transplantation (for the first 3-4 postoperative days), the tacrolimus 12-hr trough levels in the ABO-incompatible group were greater than in the ABO-compatible group. Possibly, a shorter pretreatment period with tacrolimus or a reduced target tacrolimus trough level could eliminate this difference in postoperative renal allograft function. However, 1 year after transplantation, kidney allograft function in the two study groups was similar.
Wennberg
Lars
L
Karolinska Institute, Department of Transplantation Surgery; Karolinska University Hospital, Stockholm, Sweden. lars.wennberg@karolinska.se
Genberg
Helena
H
Tydén
Gunnar
G
D000017:ABO Blood-Group System; D019540:Area Under Curve; D001781:Blood Component Removal / Q000379:methods*; D001787:Blood Group Incompatibility; D003404:Creatinine / Q000378:metabolism; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods*; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods; D014181:Transplantation Immunology; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus