title: Efficacy of risk stratification in tailoring immunosuppression regimens in kidney transplant patients at the national kidney and transplant institute.
abstract: OBJECTIVE
  To evaluate the efficacy of tailored immunosuppressive regimens prescribed according to a risk stratification scoring system based on the number of HLA mismatches, donor source, panel-reactive antibodies (PRA), and repeat transplant.
  
  
  METHODS
  Patients in a retrospective cohort of 329 kidney transplantations performed from October 2004 to December 2005 were assigned scores of 0, 2, 4, or 6 with higher scores for > or =1 HLA mismatches, PRA > 10%, repeat transplant, and unrelated or deceased donor. Added scores of < or =4 comprised the low-risk group who received a Calcineurin inhibitor (CNI)-based regimen without induction, whereas a score > or = 6 denoted high risk including a CNI-based regimen with an interleukin-2 receptor antibody. The efficacy analysis compared the incidences of biopsy-proven acute rejection episodes (BPAR) at 1 year.
  
  
  RESULTS
  Only 227 (69%) of 329 patients had a complete data set and 84 were excluded because they did not follow the prescribed protocol, yielding 113 low- and 30 high-risk patients in the final population. Low-risk patients had a mean PRA of 5.4%, living related donors in 68%, and primary transplants. High-risk patients had a mean PRA of 18.8% (range = 10%-97%), living nonrelated donors in 84%, four deceased donors, and four repeat transplants. The overall 1-year incidence of BPAR was 5.7%. No significant difference (P = .081) was observed in 1-year BPAR between the low- (4.5%) and high-risk (9.8%) groups. Likewise, no significant difference in the 1-year mean serum creatinine was observed according to the CNI. The mean creatinine was 1.12 for cyclosporine and 1.38 for tacrolimus treatment (P = .06) in the low-risk group and 1.08 for cyclosporine and 1.2 for tacrolimus (P = .61) in the high-risk cohort.
  
  
  CONCLUSIONS
  There was no significant difference in acute rejection rates between the immunologically low- or high-risk patients using tailored immunosuppression, which was effective to minimize its occurrence with good renal function at 1 year.
authors.affiliation: Department of Adult Nephrology, National Kidney and Transplant Institute, East Avenue, Quezon City, Philippines. angeledesmamd@yahoo.com
authors.forename: M A
authors.initials: MA
authors.lastname: Ledesma-Gumba
authors.forename: R A
authors.initials: RA
authors.lastname: Danguilan
authors.forename: C C
authors.initials: CC
authors.lastname: Casasola
authors.forename: E T
authors.initials: ET
authors.lastname: Ona
mesh_terms: D000047:Academies and Institutes; D016572:Cyclosporine / Q000627:therapeutic use; D005190:Family; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007376:Interleukin-2 / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010679:Philippines; D012189:Retrospective Studies; D018570:Risk Assessment; D014019:Tissue Donors
chemical_list: D007166:Immunosuppressive Agents; D007376:Interleukin-2; D016572:Cyclosporine; D009173:Mycophenolic Acid