Abstract
We conducted a retrospective analysis of the influence of full doses of calcineurin inhibitors [8-10 mg kg-1 day-1 cyclosporine (N = 80), or 0.2-0.3 mg kg-1 day-1 tacrolimus (N = 68)] administered from day 1 after transplantation on the transplant outcomes of a high-risk population. Induction therapy was used in 13% of the patients. Patients also received azathioprine (2 mg kg(-1) day(-1), N = 58) or mycophenolate mofetil (2 g/day, N = 90), and prednisone (0.5 mg kg(-1) day(-1), N = 148). Mean time on dialysis was 79 +/- 41 months, 12% of the cases were re-transplants, and 21% had panel reactive antibodies > 10%. In 43% of donors the cause of death was cerebrovascular disease and 27% showed creatinine above 1.5 mg/dL. The incidence of slow graft function (SGF) and delayed graft function (DGF) was 15 and 60%, respectively. Mean time to last dialysis and to nadir creatinine were 18 +/- 15 and 34 +/- 20 days, respectively. Mean creatinine at 1 year after transplantation was 1.48 +/- 0.50 mg/dL (DGF 1.68 +/- 0.65 vs SGF 1.67 +/- 0.66 vs immediate graft function (IGF) 1.41 +/- 0.40 mg/dL, P = 0.089). The incidence of biopsy-confirmed acute rejection was 22% (DGF 31%, SGF 10%, IGF 8%). One-year patient and graft survival was 92.6 and 78.4%, respectively. The incidence of cytomegalovirus disease, post-transplant diabetes mellitus and malignancies was 28, 8.1, and 0%, respectively. Compared to previous studies, the use of initial full doses of calcineurin inhibitors without antibody induction in patients with SGF or DGF had no negative impact on patient and graft survival.
Highlights
The incidence and duration of the delayed (DGF) and slow graft function (SGF) period after transplantation are risk factors associated with an increased incidence of acute rejection, poorer 1-year graft function and inferior long-term patient and graft survival [1]
Preexisting organ lesions, insufficient nephron mass and higher incidence of delayed graft function (DGF) are variables that may account for these results, this transplantation with non-ideal kidneys has been associated with a significant patient survival benefit compared to dialysis treatment [3]
We present here a retrospective analysis of the use of full doses of calcineurin inhibitors on the incidence of DGF/SGF, acute rejection, graft function, and patient and graft survival at 1 year
Summary
The incidence and duration of the delayed (DGF) and slow graft function (SGF) period after transplantation are risk factors associated with an increased incidence of acute rejection, poorer 1-year graft function and inferior long-term patient and graft survival [1]. Preexisting organ lesions, insufficient nephron mass and higher incidence of DGF are variables that may account for these results, this transplantation with non-ideal kidneys has been associated with a significant patient survival benefit compared to dialysis treatment [3]. Transplantation of non-ideal kidneys in patients with long periods on dialysis might be associated with an even inferior transplant outcome. Among many strategies to improve the graft outcome of patients at high risk to develop DGF/SGF is to spare the graft from exposure to early calcineurin inhibitors by using induction protocols with monoclonal or polyclonal antibody preparations [6,7,8]. The impact of induction therapy might be even more remarkable in patients with a long time on the waiting list, who already show significant co-morbidities, altered immunologic function and poor nutrition
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