De novo mTOR inhibitor-based immunosuppression in ABO-incompatible kidney transplantation.
ABO-incompatible (ABOi) kidney transplantation (KTx) has become an accepted therapeutic option in renal replacement therapy for patients without a blood group-compatible living donor. Using different desensitization strategies, most centers apply B-cell depletion with rituximab and maintenance immunosuppression (IS) with tacrolimus and mycophenolic acid. This high load of total IS leads to an increased rate of surgical complications and virus infections in ABOi patients. Our aim was to establish ABOi KTx using an immunosuppressive regimen, which is effective in preventing acute rejection without increasing the risk for viral infections. Therefore, we selected a de novo immunosuppressive protocol with low-dose calcineurin inhibitor and the mTOR inhibitor everolimus for our ABOi program. Here, we report the first 25 patients with a complete three-yr follow-up treated with this regimen. Three-yr patient survival and graft survival were 96% and 83%. The rate of acute T-cell-mediated rejections was low (12%). Cytomegalovirus (CMV) infection was evident in one patient only (4%). Surgical complications were common (40%), but mild in 80% of cases. We demonstrate that ABOi KTx with a de novo mTOR inhibitor-based regimen is feasible without severe surgical or immunological complications and a low rate of viral infections.
Department of Hepatobiliary Surgery and Transplantation, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Martina
M
Koch
Section Nephropathology, Institute of Pathology, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Thorsten
T
Wiech
HLA Laboratory, Institute of Transfusion Medicine, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Matthias
M
Marget
HLA Laboratory, Institute of Transfusion Medicine, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Sven
S
Peine
Department of Hepatobiliary Surgery and Transplantation, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Hansjörg
H
Thude
Department of Hepatobiliary Surgery and Transplantation, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Eike G
EG
Achilles
Department of Hepatobiliary Surgery and Transplantation, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Lutz
L
Fischer
Department of Hepatobiliary Surgery and Transplantation, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Anja
A
Lehnhardt
III. Medical Clinic/Nephrology, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Friedrich
F
Thaiss
Department of Hepatobiliary Surgery and Transplantation, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany.
Bjoern
B
Nashan
D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D000068338:Everolimus / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D016559:Tacrolimus / Q000627:therapeutic use
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D016559:Tacrolimus
ABO-incompatible kidney transplantation; CMV; immunosuppression; mTOR inhibitor