Journal
TRANSPLANTATION
Volume 84, Issue 3, Pages 429-432Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.tp.0000269610.13590.52
Keywords
calcineurin inhibitor; extended criteria donors; northeartbeating donors; interleukin-2 receptor antagonist; mTOR inhibitor; mycophenolate mofetil; proteinuria; rapamycin; Sirolimus; thymoglobulin
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The aim was to evaluate feasibility and safety of calcineurin inhibitor-free immunosuppression in high-risk donor kidney transplantation with sequential sirolimus introduction. Kidney transplant patients (n = 76) with a donor aged > 60years, donor with acute renal failure, ora nonheartbeating donor were included. Immunosuppression consisted of antithymocyte globulin or basiliximab, mycophenolate mofetil, prednisone, and sequential introduction of sirolimus. One-year patient survival was 96.2% and 95.8%; graft survival was 94.2% and 91.7%; acute rejection rates were 21.2% and 12.4%; delayed graft function was 21.2% and 66.7%; and creatinine clearance was 58 +/- 20 mL/min and 56- 21 mL/min for the brain-dead donor group and the nonheartbeating donor group, respectively. Most adverse events were infections, but also three lymphoceles, three urinary fistulas, three wound seromas. Sequential sirolimus introduction in high-risk donor kidney transplantation was found to lead to good patient and graft survival and incidence of acute rejection and delayed graft function.
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