THE ADDITION OF MYCOPHENOLATE AND/OR BASILIXIMAB TO CALCINEURIN INHIBITOR IMMUNOSUPPRESSION REDUCES THE HIGH RISK OF ACUTE REJECTION IN LIVE DONOR TRANSPLANTS

Abstract

A236 Aims: Live donor (LD) kidneys transplants, particularly from unrelated donors can be associated with poor HLA-matching and high risk of acute rejection. We examined the effect of the addition of MMF +/- a humanised IL-2 monoclonal antibody (basiliximab) to standard calcineurin inhibitor-based therapy on acute rejection in LDs. Methods: A consecutive series of 93 LD transplants (10 unrelated donors) were treated with standard immunosuppression consisting of a calcineurin inhibitor and prednisolone (CNI+P; n=54) or with tacrolimus and prednisolone in combination with MMF + basiliximab for patients with 1 or more HLADR mismatch (MMF+Il-2; n=41). All episodes of graft dysfunction were investigated by needle-core biopsy. Rejection episodes were classified according to Banff classification. Results: The two study groups were well matched for rejection risk factors including recipient age (32 ± 12 vs 36 ± 11 yrs; NS) and total HLA matching (2.3 ± 1.2 vs 2.2 ± 1.4 mismatches; NS). Overall rejection rates were 30/54 (56%) in the CNI+P group and 12/41 (29%) in the IL-2+MMF group (RR=1.898,P=0.0129 Fisher’s exact). Steroid resistant rejection was higher in the CNI+P group (9/54 vs 3/41;RR = 1.38, NS). For patients with 1 or more HLADR mismatch, rejection rates were higher with CNI+P [25/39 (64%) vs 10/29 (34%) P=0.027]. Conclusions: CNI-based immunosuppression in LD transplantation is associated with high rates of acute rejection. Addition of MMF +/- basiliximab significantly reduces frequency of acute rejection even in poorly matched grafts. This approach may form the basis for a new treatment paradigm in immunosuppression for high-risk LD.