Study 3: outcome of ABO-incompatible kidney transplantation immunosuppression with tacrolimus, mycophenolate mofetil, and steroids

Abstract

T o help decrease the shortage of donors, ABOincompatible living kidney transplantation is being performed. Because these patients have a higher risk of acute rejection, we have been using 1-week pretransplant immunosuppression with tacrolimus, mycophenolate mofetil, and methylprednisolone (TAC-MMF-MP), which has resulted in a marked reduction in acute humoral-vascular rejection without any serious complications. Forty-five patients with end-stage renal failure underwent ABO-incompatible living kidney transplantation at our institute between January 2000 and March 2003. There were 25 men and 19 women with a mean age of 33 years. Plasmapheresis was carried out to remove anti-AB antibodies before the kidney transplantation. In 2000, 13 patients were treated with TAC-MMF-MP without 1-week pretransplant immunosuppression (group 1). Since January 2001, we have been administering TAC (0.1 mg/kg/d)– MMF (1-2 g/d)–MP (125 mg/d) concomitantly with plasmapheresis starting from 1 week before transplantation. One week pretransplant immunosuppression with TAC-MMF-MP was given in 32 patients (group 2). In the induction phase, TACMMF-MP was used for posttransplant immunosuppression without any antibody administration, such as OKT-3 and antithymocyte globulin. Splenectomy was done at the time of kidney transplantation in all patients. Pretransplant anti-ABO antibody titer was 32 dilution or less in all cases. Patient survival was 100% in both treatment groups. Graft survival rates were 92% and 97 % in groups 1 and 2, respectively, which were almost the same as those of ABO-compatible patients. One patient in group 1 lost the graft because of severe pancreatitis, and 1 patient in group 2 lost the graft because of severe humoral rejection. The incidence rates of acute rejection were 56% (7/13) and 19% (6/32) in groups 1 and 2, respectively. Most episodes of acute rejection (about 80%) were vascular-humoral rejections in both groups. No patient experienced any severe infectious complication. Conclusion: Pretransplant immunosuppression for 1 week with TAC-MMF-MP in ABOincompatible living kidney transplantation offers an excellent outcome without any severe infectious complication. From the Department of Urology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan. © 2003 Elsevier Inc. All rights reserved. 0955-470X/03/1704-0000$30.00/0 doi:10.1016/j.trre.2003.10.004