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. PATIENTS AND 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.
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. PATIENTS AND 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: Priya S Verghese; Ty B Dunn; Srinath Chinnakotla; Kristin J Gillingham; Arthur J Matas; Michael S Mauer Journal: Nephrol Dial Transplant Date: 2014-01 Impact factor: 5.992
Authors: Zaid Brifkani; Daniel C Brennan; Krista L Lentine; Timothy A Horwedel; Andrew F Malone; Rowena Delos Santos; Thin Thin Maw; Tarek Alhamad Journal: Transplant Direct Date: 2017-02-08
Authors: Blanca Gascó; Ignacio Revuelta; Ana Sánchez-Escuredo; Miquel Blasco; Federico Cofán; Nuria Esforzado; Luis F Quintana; María José Ricart; José Vicente Torregrosa; Josep M Campistol; Federico Oppenheimer; Fritz Diekmann Journal: Transplant Res Date: 2014-02-03