Repeat renal allografts treated with sirolimus, cyclosporine, anti-thymocyte globulin induction and continuous steroids achieve similar immunosuppressive efficacy as primary transplants.
OBJECTIVE
We sought to examine repeat versus primary renal transplantations using sirolimus-based regimens.


METHODS
We compared 98 repeat versus 200 matched primary recipients treated de novo with sirolimus plus cyclosporine. Every repeat case received polyclonal antibody induction and continuous steroids. Outcomes were evaluated over a mean five-year follow-up by univariate and multivariate techniques. Kaplan-Meier plots were analyzed with using log-rank statistics with significance at P < or = 0.05.


RESULTS
Significant differences in demographic features included greater panel reactive antibody (PRA), younger age, fewer HLA-mismatches and more pre-emptive repeat versus primary grafts. Neither graft and patient survivals, nor incidences of biopsy-proven acute rejection (BPAR), chronic vasculopathy or tubular atrophy/interstitial fibrosis among biopsies performed for cause were significantly different at 1 and 5 years. Younger recipients, better HLA matches and absence of diabetes promoted repeat graft survival; whereas older age, longer cold ischemia time and BPAR reduced primary transplant outcomes. Renal function was similar at 1, 3, 12, 24, 48 and 60 months.


CONCLUSIONS
At 5 years this sirolimus regimen achieved similar efficacy for repeat versus primary transplantations.
Petero
Virgilio G
VG
Division of Immunology and Organ Transplantation, The University of Texas - Health Science Center at Houston Medical School, Houston, TX 77030, USA.
Kaposztas
Zsolt
Z
Kahan
Barry D
BD
D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation; D020123:Sirolimus / Q000627:therapeutic use*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus