An mTOR-inhibitor-based protocol and calcineurin inhibitor (CNI)-free treatment in kidney transplant recipients from donors after cardiac death: good renal function, but high incidence of conversion to CNI
In: Transplant international : official journal of the European Society for Organ Transplantation, Jg. 29 (2015-05-06), Heft 3
Online
unknown
Zugriff:
Summary Donor after cardiac death (DCD) grafts have excellent survival despite the high incidence of delayed graft function (DGF). We assessed the feasibility of a mammalian target of rapamycin inhibitor (mTOR-I) protocol in uncontrolled DCD kidney transplantation and compared it with brain-dead donor (DBD) transplantation under calcineurin inhibitor (CNI) treatment. This retrospective study (2002–2011) included 109 Maastricht category II DCD patients and 218 standard-criteria DBD as controls. Immunosuppression consisted of polyclonal antibody induction, mycophenolate mofetil, prednisone, and mTOR-I (starting on day 6) in the DCD group and tacrolimus in the DBD group. DGF occurred in 72.5% of the DCD group vs. 26.1% of the DBD group (P = 0.001). Patient survival at 1 year was 99.1% vs. 95.9% (P = 0.112), and graft survival was 89% vs. 92.2% (P = 0.253). Patient survival at 5 years was 85.3% vs. 90.1% (P = 0.340) and graft survival was 85.5% vs. 78.8% (P = 0.166). During the first year, 46.8% (n = 51) of DCD patients were converted to CNI therapy. Serum creatinine at 1 year was 1.5(1.26–2) mg/dl vs. 1.4(1.16–1.8) mg/dl (P = 0.078). At 1 year, the acute rejection rate was 7.3% vs. 12.5% (P = 0.766). mTOR-I-based therapy was not associated with inferior graft function or higher rejection rates than standard CNI therapy. DCD kidney transplantation with an mTOR-I-based protocol is feasible but is associated with a high conversion rate to CNI-based therapy.
Titel: |
An mTOR-inhibitor-based protocol and calcineurin inhibitor (CNI)-free treatment in kidney transplant recipients from donors after cardiac death: good renal function, but high incidence of conversion to CNI
|
---|---|
Autor/in / Beteiligte Person: | Peri, Lluis ; María José Ricart ; Revuelta, Ignacio ; Esforzado, Nuria ; Diekmann, Fritz ; Cofan, Frederic ; Campistol, Josep M. ; Torregrosa, Jose-Vicente ; Sánchez-Escuredo, Ana ; Oppenheimer, Federico ; Angel Recio Ruiz |
Link: | |
Zeitschrift: | Transplant international : official journal of the European Society for Organ Transplantation, Jg. 29 (2015-05-06), Heft 3 |
Veröffentlichung: | 2015 |
Medientyp: | unknown |
ISSN: | 1432-2277 (print) |
Schlagwort: |
|
Sonstiges: |
|