Vega O, Pérez-Gutiérrez A, Hernández-Ordóñez S, Correa-Rotter R, Alberú J, Morales-Buenrostro LE

Language: Spanish
References: 10
Page: 200-205
PDF size: 66.28 Kb.

ABSTRACT

Introduction. The recipients of HLA-identical live-donors grafts (RKT 2HP) have a low immunologic risk, and it is common to use immunosuppressive regimen with two medicaments excluding the calcineurin inhibitor. This study compares the long term outcomes of the double immunosuppressive therapy versus the triple therapy in RKT 2HP. Materials and methods. This study is a retrolective cohort. The patients were divided in two groups: 1) RKT 2HP who receive double immunosupresive therapy and 2) RKT 2HP with triple immunosupresive therapy. The outcomes evaluated were: renal function, acute rejection rate, lost of renal allograft, death rate, infections and hospitalization, change in the immunosupresive therapy and its causes. Results. We analyzed 85 kidney transplant recipients who share two haplotypes, 60 in the group 1 and 25 in the group 2. The median of time of follow-up in the group 1 was 138 months (min 23 and max 302) and 55 months (min 12 and max 106) in the group 2. There were four cellular acute rejection and nine allograft lost in patients of the group 1. There wasn´t any significant difference between the allograft outcome and the renal function at 60 months of follow out between the groups. 23 patients had change in the immunosuppressive therapy, 12 (53%) in the group 1 and 11 (47%) in the group 2. The major cause of change of therapy in the group 1 was leucopenia by azatioprin (five patients); and in the group 2 was nephrotoxicity for calcineurin inhibitor (six patients). Discussion. Despite the evident nephrotoxicity, the use of calcineurin inhibitor is useful even in patients with low immunologic risk. According to the time of follow-up between the groups, even when the allograft survival was superior in group 2, the difference wasn´t significative, it might be because the lower number of patients in group 1.

REFERENCES

1. Halloran PF. Immunosuppressive drugs for kidney transplantation. N Engl J Med 2004; 351(26): 2715-29.

2. Yang H. Maintenance immunosuppression regimens: conversion, minimization, withdrawal, and avoidance. Am J Kidney Dis 2006; 47(4 Suppl. 2): S37-S51.

3. Calne R. Cyclosporine as a milestone in immunosuppression. Transplant Proc 2004; 36(2 Suppl.): S13-S15.

4. Ekberg H. Calcineurin inhibitor sparing in renal transplantation. Transplantation 2008; 86(6): 761-7.

5. Opelz G, Wujciak T, Döhler B, Scherer S, Mytilineos J. HLA compatibility and organ transplant survival. Collaborative Transplant Study. Rev Immunogenet 1999; 1(3): 334-42.

6. Pascual M, Theruvath T, Kawai T, Tolkoff-Rubin N, Cosimi AB. Strategies to improve long-term outcomes after renal transplantation. N Engl J Med 2002; 346(8): 580-90.

7. Nankivell BJ, Borrows RJ, Fung CL, O’Connell PJ, Allen RD, Chapman JR. The natural history of chronic allograft nephropathy. N Engl J Med 2003; 349(24): 2326-33.

8. Nankivell BJ, Borrows RJ, Fung CL, O’Connell PJ, Chapman JR, Allen RD. Calcineurin inhibitor nephrotoxicity: longitudinal assessment by protocol histology. Transplantation 2004; 78(4): 557-65.

9. 9 . Câmara NO, Dias MF, Pacheco-Silva A. An open randomized study comparing immunosuppression therapy initiated before or after kidney transplantation in haploidentical living recipients. Clin Transplant 2004; 18(4): 450-5.

10. Opelz G; Collaborative Transplant Study. Non-HLA transplantation immunity revealed by lymphocytotoxic antibodies. Lancet 2005; 365(9470): 1570-6.