Impact of daclizumab, low-dose cyclosporine, mycophenolate mofetil and steroids on renal function after kidney transplantation.
BACKGROUND
Early and long-term use of cyclosporine A (CsA) leads to increased risks of renal toxicity. We hypothesized that administration of daclizumab in combination with mycophenolate mofetil (MMF) allows a relevant reduction in the dose of CsA.


METHODS
We carried out a 3-year, prospective, randomized, controlled clinical multi-centre trial in 156 patients. The patients were randomized to standard treatment (CsA, MMF, steroids) or to high-dose daclizumab (first dose: 2 mg/kg), in combination with low-dose CsA, MMF and steroids. We maintained the mean CsA levels of daclizumab patients at 57% of standard patients (132 versus 216 ng/ml) on Day 7 post-transplant, and 84% by 6 months.


RESULTS
Primary outcome, creatinine clearance (with imputation of informative dropouts) at 12 months, was significantly better in daclizumab-treated (34 +/- 17) than standard patients (29 +/- 17; P = 0.028, two sided). Only 5 cases of BPAR were recorded in the daclizumab compared to 22 in the standard group (P = 0.0016). Daclizumab patients had 91% event-free survival after 1 year compared to 66% in standard patients (P = 0.00017).


CONCLUSIONS
We demonstrate here that high-dose daclizumab in combination with lower CsA levels in adult renal transplant recipients is as or more effective than standard regimen (CsA, MMF, steroids) and may result in better outcomes at 12 months post-transplant with no increase in adverse reactions.
Klinik fuer Visceral, Transplantations, Thorax und Gefaesschirurgie, Universitaetsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany. Josef.Fangmann@Karl-Olga-Krankenhaus.de
Josef
J
Fangmann
Wolfgang
W
Arns
Hans-Peter
HP
Marti
Johann
J
Hauss
Markus
M
Ketteler
Tobias
T
Beckurts
Claudia
C
Boesmueller
Erich
E
Pohanka
Pierre-Yves
PY
Martin
Moritz
M
Gerhardt
Stefan
S
Farese
Hans-H
HH
Neumayer
Juergen
J
Floege
Caroline
C
Gurr
Klemens
K
Budde
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000494:pharmacology* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001706:Biopsy; D016572:Cyclosporine / Q000494:pharmacology* / Q000627:therapeutic use; D000077561:Daclizumab; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007074:Immunoglobulin G / Q000494:pharmacology* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000502:physiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D013256:Steroids / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D000077561:Daclizumab; D009173:Mycophenolic Acid