Background: To avoid Calcineurin Inhibitor (CI) nephrotoxicity, a CI-freeprotocol was introduced in our centre, as immunosuppressive therapy (IT) indual kidney transplantation (DKT) from marginal donors.Methods: Donor kidneys were histologically evaluated according to Remuzziscore (J Am Soc Nephrol 1999). Fifteen DKT were performed since February2009 with the following IT: basiliximab, steroids, mycophenolate sodium(1440 mg/die), sirolimus (n = 12) or everolimus (n = 3). Mean age of recipientswas 66 years (range 61-71) whereas mean donors age was 68.5 years (range55-78). All patients were analyzed for donor specific HLA-antibodies (HLA-DSA) by solid phase Luminex Single Antigen bead assay, at 1 and 6 monthsfrom KT and then yearly.Results: Median follow up was 35.7 months (range 1-73). Cumulativeincidence of acute rejection (AR) was 33.3% (5/15). ARs were biopsy proven,within 90 postoperative days and responsive to steroids treatment. The mediancreatinine at last follow-up was 1.5 mg/dl (range 0.8-2.8). Steroids werestopped in 7 recipients due to new onset diabetes. No deaths or graft lossesoccurred throughout the follow-up. No patient developed HLA-DSA throughoutthe follow-up.Discussion/Conclusions: AR episodes occurred when recipients wereunder-immunosuppressed for IT adverse events: sirolimus/everolimus bloodlevel under 5 ng/ml (n = 3), early steroid withdrawal (n = 1), or during acutetubular necrosis (n = 1). In our experience CI free IT provides good results inDKT, with excellent long term graft function. Special care should be taken insuch aged recipients with several comorbidity factors. Dual KT is oftenperformed with low HLA compatibility and adequate IT should be constantlyachieved. Hence we recommend sirolimus/everolimus trough levels on the highside of their therapeutic range in the first 6 months post KT.
CALCINEURIN INHIBITOR-FREE IMMUNOSUPPRESSION IN DUAL KIDNEY TRANSPLANTATION FROM MARGINAL DONORS - SINGLE CENTRE EXPERIENCE
Poggi Elvira;
2015
Abstract
Background: To avoid Calcineurin Inhibitor (CI) nephrotoxicity, a CI-freeprotocol was introduced in our centre, as immunosuppressive therapy (IT) indual kidney transplantation (DKT) from marginal donors.Methods: Donor kidneys were histologically evaluated according to Remuzziscore (J Am Soc Nephrol 1999). Fifteen DKT were performed since February2009 with the following IT: basiliximab, steroids, mycophenolate sodium(1440 mg/die), sirolimus (n = 12) or everolimus (n = 3). Mean age of recipientswas 66 years (range 61-71) whereas mean donors age was 68.5 years (range55-78). All patients were analyzed for donor specific HLA-antibodies (HLA-DSA) by solid phase Luminex Single Antigen bead assay, at 1 and 6 monthsfrom KT and then yearly.Results: Median follow up was 35.7 months (range 1-73). Cumulativeincidence of acute rejection (AR) was 33.3% (5/15). ARs were biopsy proven,within 90 postoperative days and responsive to steroids treatment. The mediancreatinine at last follow-up was 1.5 mg/dl (range 0.8-2.8). Steroids werestopped in 7 recipients due to new onset diabetes. No deaths or graft lossesoccurred throughout the follow-up. No patient developed HLA-DSA throughoutthe follow-up.Discussion/Conclusions: AR episodes occurred when recipients wereunder-immunosuppressed for IT adverse events: sirolimus/everolimus bloodlevel under 5 ng/ml (n = 3), early steroid withdrawal (n = 1), or during acutetubular necrosis (n = 1). In our experience CI free IT provides good results inDKT, with excellent long term graft function. Special care should be taken insuch aged recipients with several comorbidity factors. Dual KT is oftenperformed with low HLA compatibility and adequate IT should be constantlyachieved. Hence we recommend sirolimus/everolimus trough levels on the highside of their therapeutic range in the first 6 months post KT.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
