Abstract
(Background) Acute rejection episode following ABO blood-type incompatible renal transplantation (ABOI-RTx) is a major problem in it. To surmount it, we launched early administration of immunosuppressants prior to ABOI-IRTx along with induction therapy using anti-CD 20 and 25 monoclonal antibodies. (Method) 128 ABOI-RTx were conducted at our department from May 2007 to December 2012. We retrospectively reviewed clinical outcomes of these cases according to their types of protocols, all of which were accomplished with the induction of both anti-CD 20 and 25 antibodies. We did not prescribe any immunosuppressants to patients in Group A (n=85) until just before surgery. We started administration of either Tacrolimus (1 or 2 mg/day) or MMF (250 or 500 mg/day) to patients in Group B (n=22) for one month before transplantation. Recipients in Group C (n=21) received prescription of both Tacrolimus and MMF with the same doses for the same period. Acute rejection free ratios (ARfr) and eGFR were compared between them, along with PRA positivity rates before vs. after surgery in each group. (Results) 6 month-ARfr of Group A vs. B vs. C was 0.917 vs. 0.955 vs. 1.0, 12 month-ARfr: 0.877 vs. 0.904 vs. 1.0, and 24 month-ARfr: 0.862 vs. 0.822 vs. 1.0, respectively (p>0.05). 6 month-eGFR (ml/min) of Group A vs. B vs. C was 37.9±8.7 vs. 38.3±9.7 vs. 38.1±12.6, 12 month-eGFR: 44.1±7.5 vs. 40.9±13.0 vs. 45.0±11.5, and 24 month-eGFR: 54.9±12.4 vs. 33.5±16.7 vs. 46.2±14.7, respectively (p>0.05). There was no significant change in the prevalence of PRA positivity rates before vs. after transplant (p>0.05). (Conclusion) The Group C desensitized was rejection free for 2 years after transplantation, though there was no significant difference of AR free rations with other groups probably due to lack of statistical power. It suggests that the early administration of Tacrolimus and MMF might be effective in the prevention of acute rejection. Expression of Cytosolic DoubleFigure: No Caption available.
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