Logo Annals of Transplantation Logo Annals of Transplantation Logo Annals of Transplantation

21 May 2009

Kidney transplantation in sensitized patients

M Durlik, O Tronina, T Bączkowska, M Klinger, B Rutkowski, A Więcek, M Ostrowski, L Pączek, J Szmidt, W Rowiński

Ann Transplant 2009; 14(1): 13-14 :: ID: 880243

Abstract

Sensitization is defi ned as the presence of preformed alloantibodies in the
serum prior to transplantation. Highly sensitized patients present limited
access to organs and increased risk of acute humoral rejection. Aspects of
immunosuppression of highly sensitized kidney transplant patients include
desensitization therapy prior to transplantation, induction therapy with transplantation, maintenance therapy after transplantation and rescue therapy of acute humoral rejection. The aim of this multicenter, randomized study was to determine efficacious and safe immunosuppressive regimen in renal transplant recipients. Sixty two (30 males) sensitized cadaveric renal transplant recipients, aged 15-55 years, were included in the study and followed-up for 36 months. High immunologic risk was defined as retransplantation (2[sup]nd[/sup] [n=34] or 3[sup]rd[/sup][n=l graft) in pts with history of immunologic complications or PRA >25%. PRA range was 0-24% (n=28), 25-36% (n=23), and >36% (n=11). HLA mismatches (MM) in class I (A + B) were 16.1, 26, 35.5, 11.4, and 4.8%, for 4, 3, 2, 1 and 0 MM, respectively and in class II (DR) were 14.5, 5, and 26% for 2, 1 and 0 MM, respectively. Pts were randomized to receive ATG (3 mg/kg; 4 doses) + Steroids + Tacrolimus (Tac) and either mycophenolate mofetil (MMF) (n=40) or Sirolimus (Sir) (n=22). 1-year graft and patient survival were estimated with Kaplan-Meier method. Renal function (expressed as estimated GFR [eGFR calculated by MDRD formula] was monitored for 24 months. Renal function was stable in both MMF and Sir groups, with eGFR slope significantly more positive in MMF group over 2 years after transplantation (p<0.045). Delayed graft function was observed in 35.5% pts. In 39% pts biopsy-proven acute rejection episodes were diagnosed (early [up to month 3] in 17%, late in 20%), in 32.5% pts on MMF, and in 45.5% on Sir. Significantly higher cholesterol and trigliceryde levels, and lower hemoglobin and hematocrit were observed in Sir group. 8 kidney grafts were lost during follow-up 5 and 3 in MMF and Sir groups, respectively. 4 patients were converted from Rapa to MMF due to thrombotic microangiopathy, 2 patients from MMF to Sir due to neoplasia. Serious complications were comparable in both groups (1 pts died [brain abscess], 1 nephrectomy [renal cell carcinoma], l pulmonary aspergillosis). MMF-based immunosuppressive regimen proved more safe and efficacious than sirolimus-based therapy in high immunologic risk kidney transplantation, resulting in better graft function and lower incidence of adverse effects. Kaplan-Meier estimates of l-year patient and graft survival showed a trend in benefit of MMF.

Keywords: Kidney Transplantation

Comments

In Press

06 May 2022 : Original article  

Phosphatidylethanol (PEth) for Monitoring Sobriety in Liver Transplant Candidates: Preliminary Results of D...

Ann Transplant In Press; DOI: 10.12659/AOT.936293  

Most Viewed Current Articles

26 Jan 2022 : Review article  

Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models

DOI :10.12659/AOT.934924

Ann Transplant 2022; 27:e934924

29 Dec 2021 : Original article  

Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...

DOI :10.12659/AOT.933588

Ann Transplant 2021; 26:e933588

24 Jul 2020 : Review article  

Kidney Transplantation in the Times of COVID-19 – A Literature Review

DOI :10.12659/AOT.925755

Ann Transplant 2020; 25:e925755

15 Mar 2022 : Case report  

Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...

DOI :10.12659/AOT.935860

Ann Transplant 2022; 27:e935860

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358