title: Calcineurin inhibitor-free monotherapy in human leukocyte antigen–identical live donor renal transplantation.
abstract: BACKGROUND
  Most recent trials in human leukocyte antigen (HLA)-identical living donor (LD) renal transplantation have used immunosuppressive regimens with no induction therapy, corticosteroid-free long-term treatment, and calcineurin inhibitor minimization.
  
  
  METHODS
  Seven HLA-identical LD recipients were prospectively enrolled. Immunosuppression included induction therapy with antithymocyte globulins for 10 days and long-term monotherapy with mycophenolate mofetil (2 g/day) in six cases and sirolimus (target trough levels: 6-10 ng/mL) in the last case. A single preoperative steroid bolus was administered.
  
  
  RESULTS
  After a median follow-up time of 26 months (range: 5-50 months), patient and graft survival was 100%. Only one patient experienced borderline lesions at 3 months and received steroids for a 5-month period. All patients had a protocol biopsy at 3 months, and four had a second at 12 months. Acute cellular rejection was not observed. Median serum creatinine at 3 months, 12 months, and last follow-up were 103.1, 107.1, and 106.1 [mu]mol/L, respectively. For four patients, measured glomerular filtration rate was evaluated at 3 months, and the mean value was 71.2 mL/min/1.73 m2.
  
  
  CONCLUSIONS
  Induction therapy with antithymocyte globulins followed by mycophenolate mofetil or sirolimus monotherapy provides excellent patient and graft survival, excellent renal function, and no acute rejection episodes in HLA-identical LD renal transplant recipients.
authors.affiliation: Nephrology and Transplantation Department, Saint-Louis Hospital, Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Venot
authors.forename: Imad
authors.initials: I
authors.lastname: Abboud
authors.forename: Alain
authors.initials: A
authors.lastname: Duboust
authors.forename: Catherine
authors.initials: C
authors.lastname: Michel
authors.forename: Caroline
authors.initials: C
authors.lastname: Suberbielle
authors.forename: Jerome
authors.initials: J
authors.lastname: Vérine
authors.forename: Martin
authors.initials: M
authors.lastname: Flamant
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Denis
authors.initials: D
authors.lastname: Glotz
authors.forename: Marie-Noelle
authors.initials: MN
authors.lastname: Peraldi
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001706:Biopsy; D065095:Calcineurin Inhibitors; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology / Q000502:physiology; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus