Single Center Analysis of the Incidence of Acute Rejection in Cadaver Renal Allograft Recipients Induced with Low Dose OKT3 with and without Mycofenalate Mofetil (MMF)

Abstract

240 Multicenter trials have shown that MMF reduces the frequency of acute rejection (AR) episodes following cadaveric renal transplantation to as low as 25% at 3 months Previously reported data from our institution (ASTP 1995) has shown that the use of low dose OKT3 (2.5 mg/d) induction results in comparatively reduced AR rates (15-20%) without MMF. With this in mind, we retrospectively reviewed our patients receiving standard low dose OKT3 induction immunosuppression consisting of OKT3 2.5 mg/d× 14 doses, Methylprednisolone (MP) 250 mg/d × 3 d followed by prednisone 6 mg/kg/d & cyclosporine 8 mg/kg/d (target level 350-400 ng/ml) with either azathioprine 2 mg/kg/d (Group I) vs. MMF 1 g bid (Group II). Rejection episodes were determined clinically and in most cases verified with allograft biopsy. Rejections were treated with MP 250 mg/d × 3 days and with OKT3 5 mg/d × 10 doses for steroid resistant rejections. Both groups were similar with respect to age, etiology of ESRD, comorbidities, HLA mismatch, cold ischemic time and CMV status. TableWe conclude that the incidence of AR following CRA with the combination of low dose OKT3 induction and MMF is significantly reduced below reported rates of the use of either drug alone. This additive effect helps offset the increased cost of MMF.