No abstract

Low-dose tacrolimus combined with a MMF dose of 1 g daily and corticosteroids provided an optimized efficacy and safety profile. A higher dose of MMF (2 g) was associated with greater toxicity without a significant improvement in efficacy.

Modern immunosuppressive regimens reduce the acute rejection rate by combining a cornerstone immunosuppressant like tacrolimus or cyclosporine with adjunctive agents like corticosteroids, mycophenolate mofetil (MMF) or azathioprine, often associated with untoward side effects.A 6-month randomized study was conducted in 47 European centers. Triple therapy with tacrolimus (trough levels 5-15 ng/mL), corticosteroids (dosage 10 mg/day) and MMF (1 g/day) was administered for 3 months. From day 92, patients either continued with triple therapy (control, n = 277), or stopped steroids (n = 279), or stopped MMF (n = 277). Surrogate markers for long-term benefits were changes in lipid profiles and occurrence of hematological, gastrointestinal and infectious complications.The 6-month acute rejection incidence (biopsy-proven) was similar in all groups (17.0% vs. 15.1% vs. 14.8%, p = 0.744), although the incidence after month 3 was higher in the steroid stop group than in the two other groups. Mean reductions in total cholesterol In a study population of immunologically low-risk patients' withdrawal of corticosteroids or MMF from a tacrolimus-based therapy at 3 months was feasible. A longer follow-up will be needed to confirm the expected advantages for the long-term outcome and to assess the long-term safety of this minimization of immunosuppressive therapy.

No abstract

single centre propectively collected outcome results on an early steroid withdrawal, low dose tacrolimus based immunosuppression in low immunologic risk living donor kidney transplantation. Induction therapy consisted of either 2 doses of basiliximab given 4 days apart or 2 doses of daclizumab, 1 mg/kg body wt, given 2 weeks apart. I.v. methylprednisolone 500 mg/day was given for 3 days beginning on day 0. Oral prednisolone was administered at a dose of 30/day for 3 days, 20 mg/day for 3 days, 15 mg/day for 3 days, 10 mg/ day for 3 days and continued on 5.0 mg/day until day 30 post transplant. Tacrolimus was started at a dose of 0.2 mg/kg body wt the night before the transplant, tacrolimus dose was adjuested to maintain the trough level at 8-12 ug/L for the fi rst 3 months, 5-8 ug/L from 3-12 months and 4-6 ug/L onwards. Mycophenolate was given at a dose of 750 mg b.i.d. for the fi rst 3 months and reduced to 500 mg b.i.d. later. Protocol biopsy was performed at day 10 post transplant, all suspected acute rejection episodes were biopsied. The 1-year acute rejection rate, 1-, 5-and 10-years patient and graft survival rates were studied. A total of 210 patients, mean age; 55.3±12.1 years (range 8-78 years), males:female; 136:64 were studied. Diabetes mellitus was the cause of endstage renal disease in 60% of patients. Subclinical rejection was detected in 5% of patients on protocol biopsy but was not treated if there was no rise in serum creatinine. The 1-year biopsy-confi rmed acute rejection and steroid-resistant rejection rates were 10% and 2% respectively. The 1-, 5-, and 10-years death censored graft survival rates were 99%, 95% and 90% respectively. The 1-, 5-and 10-years patient survival rates were 100%, 92% and 85% respectively. De novo diabetes mellitus occurred in 7% of patients at 1-year. 5/210 patients developed malignancy, 4 were PTLDs. In conclusion, early steroid withdrawal, low dose tacrolimus and mycophenolate based immunosuppression with anti-IL2 receptor induction therapy is an effective immunosuppression regimen with minimal complications for living donor kidney transplantation.