Use of different immunosuppressive strategies in recipients of kidneys from nonheart-beating donors

Sánchez‐Fructuoso, Ana; Marqués, María; Conesa, J.; Ridao, N.; Rodriguez, A; Blanco, Julia; Barrientos, Alberto

doi:10.1111/j.1432-2277.2005.00100.x

Cited by 16 publications

(10 citation statements)

References 22 publications

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“…Both RATG and IL-2R antagonists reduce the ischemia/reperfusion injury, possibly by blocking integrin expression on endothelial and T cells and by inhibiting leukocyte adherence to the vessel walls [9, 20–22]. Thus, with dual induction the two drugs could synergistically contribute to accelerate posttransplant renal function recovery.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Minimal Induction Therapy: A Further Step toward More Effective Immunosuppression in Transplantation

Gennarini

Cravedi²,

Marasà³

et al. 2012

Journal of Transplantation

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Dual induction with low doses of rabbit anti-human thymoglobulin (RATG) and basiliximab effectively and safely prevented allograft rejection in high-risk renal transplant recipients. To assess whether treatment timing affects efficacy and tolerability, in this single-center, matched-cohort study, we compared posttransplant outcomes in 25 patients and 50 gender-, age-, and treatment-matched reference patients induced with the same course of 7 daily RATG infusions (0.5 mg/kg/day) started before or after engraftment, respectively. All subjects received basiliximab (20 mg) before and 4 days after transplantation, withdrew steroids within 6 days after surgery, and were maintained on steroid-free immunosuppression with cyclosporine and mycophenolate mofetil or azathioprine. Over 12 months after transplant, 1 patient (4%) and 13 reference patients (26%) had acute rejection episodes. One patient and 5 reference-patients required dialysis therapy because of delayed graft function. In all patients circulating CD4+ and CD8+ T lymphocytes were fully depleted before engraftment. Both treatments were well tolerated. In kidney transplantation, perioperative RATG infusion enhances the protective effect of low-dose RATG and basiliximab induction against graft rejection and delayed function, possibly because of more effective inhibition of early interactions between circulating T cells and graft antigens.

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Section: Discussionmentioning

confidence: 99%

Perioperative Minimal Induction Therapy: A Further Step toward More Effective Immunosuppression in Transplantation

Gennarini

Cravedi²,

Marasà³

et al. 2012

Journal of Transplantation

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“…The incidence of PNF and DGF is increased in DCD kidney transplantation. Few studies discuss protocols for improving the outcome of DCD transplant procedures .…”

Section: Dcd Kidney Transplant Managementmentioning

confidence: 99%

Recommendations for donation after circulatory death kidney transplantation in Europe

Heurn

Talbot

Nicholson³

et al. 2015

Transpl Int

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SUMMARY Donation after circulatory death (DCD) donors provides an invaluable source for kidneys for transplantation. Over the last decade, we have observed a substantial increase in the number of DCD kidneys, particularly within Europe. We provide an overview of risk factors associated with DCD kidney function and survival and formulate recommendations from the sixth international conference on organ donation in Paris, for bestpractice guidelines. A systematic review of the literature was performed using Ovid Medline, Embase and Cochrane databases. Topics are discussed, including donor selection, organ procurement, organ preservation, recipient selection and transplant management.

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“…DCD transplants have been related to a higher incidence of DGF, PNF, and, in some reports, to a higher incidence of AR . In most centers, these results were obtained with CNI‐based immunosuppressive regimens, but with minimization of CNI exposure .…”

Section: Discussionmentioning

confidence: 99%

“…Following the positive experiences already reported with CNI treatment , in our study, we aimed to explore an mTOR‐I‐based protocol as an alternative to CNI protocols.…”

Section: Discussionmentioning

confidence: 99%

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An mTOR-inhibitor-based protocol and calcineurin inhibitor (CNI)-free treatment in kidney transplant recipients from donors after cardiac death: good renal function, but high incidence of conversion to CNI

et al. 2016

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SummaryDonor after cardiac death (DCD) grafts have excellent survival despite the high incidence of delayed graft function (DGF). We assessed the feasibility of a mammalian target of rapamycin inhibitor (mTOR-I) protocol in uncontrolled DCD kidney transplantation and compared it with brain-dead donor (DBD) transplantation under calcineurin inhibitor (CNI) treatment.This retrospective study (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) included 109 Maastricht category II DCD patients and 218 standard-criteria DBD as controls. Immunosuppression consisted of polyclonal antibody induction, mycophenolate mofetil, prednisone, and mTOR-I (starting on day 6) in the DCD group and tacrolimus in the DBD group. DGF occurred in 72.5% of the DCD group vs. 26.1% of the DBD group (P = 0.001). Patient survival at 1 year was 99.1% vs. 95.9% (P = 0.112), and graft survival was 89% vs. 92.2% (P = 0.253). Patient survival at 5 years was 85.3% vs. 90.1% (P = 0.340) and graft survival was 85.5% vs. 78.8% (P = 0.166). During the first year, 46.8% (n = 51) of DCD patients were converted to CNI therapy. Serum creatinine at 1 year was 1.5(1.26-2) mg/dl vs. 1.4(1.16-1.8) mg/dl (P = 0.078). At 1 year, the acute rejection rate was 7.3% vs. 12.5% (P = 0.766). mTOR-I-based therapy was not associated with inferior graft function or higher rejection rates than standard CNI therapy. DCD kidney transplantation with an mTOR-I-based protocol is feasible but is associated with a high conversion rate to CNI-based therapy.

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Use of different immunosuppressive strategies in recipients of kidneys from nonheart-beating donors

Cited by 16 publications

References 22 publications

Perioperative Minimal Induction Therapy: A Further Step toward More Effective Immunosuppression in Transplantation

Perioperative Minimal Induction Therapy: A Further Step toward More Effective Immunosuppression in Transplantation

Recommendations for donation after circulatory death kidney transplantation in Europe

An mTOR-inhibitor-based protocol and calcineurin inhibitor (CNI)-free treatment in kidney transplant recipients from donors after cardiac death: good renal function, but high incidence of conversion to CNI

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