Nephrology Dialysis Transplantation, Vol 13, Issue 10 2601-2604, Copyright © 1998 by Oxford University Press
J Grinyo, S Gil-Vernet, D Seron, M Hueso, X Fulladosa, J Cruzado, F Moreso, A Fernandez, J Torras, L Riera, A Castelao and J Alsina
Background. In renal transplantation the beneficial
immunosuppressive effects of cyclosporin (CsA) may be curtailed by its
nephrotoxicity, specially in patients receiving a cadaveric allograft from
suboptimal donors or at risk of delayed graft function. Mycophenolate
mofetil (MMF) and antithymocyte globulin (ATG) have each demonstrated to be
potent immunosuppressants in renal transplantation. In a prospective
analysis we have studied the results at 6 months of the combination of MMF,
ATG and low-dose steroids in patients with low immunological risk receiving
a first cadaveric renal allograft from a suboptimal donor or at risk of
delayed graft function. Methods. Patients with
preformed reactive antibodies <50% receiving a first graft from a
suboptimal donor (age ⩾40years, non-heart-beating, acute renal
failure, arterial hypertension) or at risk of delayed graft function (cold
ischaemia time ⩾24 h) were eligible for this open single-arm pilot
trial. From September 1996 to March 1997 we recruited 17 patients. They
were treated with MMF 2 g p.o. preoperatively, and after transplantation at
3 g/day; rabbit ATG i.v. at 2 mg/kg preoperatively, and 1.5 mg/kg/day the
first day after transplantation, followed by four doses of 1 mg/kg on
alternate days; prednisone was given at 0.25 mg/kg/day and reduced
progressively to 0.1 mg/kg/day at 3 months. Primary outcomes were incidence
of biopsy-proven acute rejection, delayed graft function, opportunistic
infections, graft and patient survival, and the need for introduction of
CsA treatment. Results. Delayed graft function
occurred in two cases (12%). Four of 17 patients (27%) had a biopsy-proven
acute rejection (2 grade I and 2 grade II) within the first 3 months after
transplantation. CsA was added in two cases with grade II biopsy-proven
acute rejection, and in one with grade I biopsy-proven acute rejection. In
one patient MMF was replaced by CsA because of gastrointestinal
intolerance. Mean serum creatinine 6 months after transplantation was
159±59 &mgr;mol/l. Cytomegalovirus tissue invasive disease
occurred in one patient (6%). At 6 months follow-up all patients are alive
with functioning allografts. Conclusions. These
preliminary results suggest that in low-immunological-risk patients who
receive a suboptimal renal allograft or at risk of delayed graft function,
the combination of MMF, ATG, and steroids is an efficient immunosuppressive
regime that may avoid the use of CsA in 70% of the recipients.
Keywords: antithymocyte globulin; mycophenolate
mofetil; suboptimal grafts
ORIGINAL ARTICLES
Primary immunosuppression with mycophenolate mofetil and antithymocyte globulin for kidney transplant recipients of a suboptimal graft
Departments of Nephrology and Urology, Hospital de Bellvitge, CSUB, University of Barcelona, C Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain; Corresponding author
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