Immunosuppression without calcineurin inhibition: optimization of renal function in expanded criteria donor renal transplantation

Clinical Transplantation
Patrick P W LukeAndrew A House

Abstract

To assess the efficacy of calcineurin inhibitor (CNI)-free immunosuppression vs. calcineurin-based immunosuppression in patients receiving expanded criteria donor (ECD) kidneys. Thirteen recipients of ECD kidneys were enrolled in this pilot study and treated with induction therapy and maintained on sirolimus, mycophenolate mofetil (MMF) and prednisone. A contemporaneous control group was randomly selected comprised of 13 recipients of ECD kidneys who had been maintained on CNI plus MMF and prednisone. For the study group vs. the control group, two-yr graft survival was 92.3% vs. 84.6% (p = NS), two-yr patient survival was 100% vs. 92.3% (p = NS) and the acute rejection rates were 23% vs. 31% (p = NS), respectively. Renal function was significantly better in the study group compared with control up to the six-month mark, after which, it remained numerically but not statistically significant. Complications were more common in the study group, but serious adverse events requiring discontinuation were rare. This pilot study demonstrates that CNI-free regimens can be safely implemented in patients receiving ECD kidneys with excellent two-yr patient and graft survival and good renal allograft function. Longer follow-up in larger rand...Continue Reading

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Citations

Jan 11, 2017·Transplantation·María José Pérez-SáezJulio Pascual
Mar 25, 2016·World Journal of Transplantation·Vassilis Filiopoulos, John N Boletis
Oct 9, 2009·Current Opinion in Organ Transplantation·Jason RheeRichard Freeman

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