CORTICOSTERIOID ELIMINATION IN RENAL TRANSPLANTATION: EXPERIENCE IN HIGH IMMUNOLOGIC RISK RECIPIENTS

Abstract

P246 Body: Rejection rates with early corticosteroid elimination (ECE) in renal transplantation (Tx) have fallen substantially with the use of new potent immunosuppressive (IS) agents. Although high immunologic risk (HIR) renal Tx patients (pts) have been included in a few recent ECE trials, the risk of acute rejection (AR) in HIR pts remains to be defined under modern IS. The purpose of this study was to compare the risk of AR in HIR and low IR (LIR) pts with modern IS. Methods: 98 male and 66 female renal Tx pts. In IRB approved ECE studies were analyzed. Statistical analysis included chi square test. HIR was defined as current or peak PRA>25% or repeat Tx, and LIR was defined as repeat Tx, or current PRA>25%, or peak PRA>25%. IS included Thymoglobulin (51%), IL-2R MAb (15%), steroids <7d (23%), no steroids (77%), MMF (91%), FK506 (60%), CsA (39%), Rapa (68%). Results: No differences existed between HIR and LIR with other risk factors for AR including African American race, cadaveric donor, and DGF. Conclusion: This experience represents the largest reported experience to date in HIR pts with ECE under modern IS. This experience indicates that: 1) HIR pts have higher AR rates at 1 yr, 2) HIR pts without DGF had lower AR with Thymoglobulin induction, 3) poor HLA DR matching increased AR risk in LIR but not HIR pts.Figure