Both authors contributed equally to this work.
Calcineurin-inhibitor avoidance in elderly renal allograft recipients using ATG and basiliximab combined with mycophenolate mofetil
Article first published online: 28 JUN 2008
© 2008 The Authors. Journal compilation © 2008 European Society for Organ Transplantation
Volume 21, Issue 7, pages 637–645, July 2008
How to Cite
Guba, M., Rentsch, M., Wimmer, C. D., Uemueksuez, A., Illner, W.-D., Schönermarck, U., Gottlieb Land, W., Jauch, K.-W. and Arbogast, H. (2008), Calcineurin-inhibitor avoidance in elderly renal allograft recipients using ATG and basiliximab combined with mycophenolate mofetil. Transplant International, 21: 637–645. doi: 10.1111/j.1432-2277.2008.00658.x
- Issue published online: 28 JUN 2008
- Article first published online: 28 JUN 2008
- Received: 5 August 2007 Revision requested: 14 September 2007 Accepted: 21 January 2008
- calcineurin-inhibitor-free immunosuppression;
- ET senior program;
- old-to-old program
In old recipients of renal allografts from old donors, benefits of calcineurin-inhibitors (CNI) are curtailed by nephrotoxicity. Intending to improve the outcome of these recipients, we analyzed a CNI-free immunosuppressive regimen consisting of anti-thymocyte globulin (ATG), basiliximab, mycophenolate mofetil (MMF) and steroids. Kidney allograft recipients with low immunological risk (panel reactive antibodies <30%) were eligible for this study. Immunosuppression induction included ATG (4 mg/kg, day 0), basiliximab (20 mg, day 0 + 4) and steroids, followed by MMF (TL 2–6 μg/ml) and steroid maintenance treatment. Patient and graft survival rates respectively were 89.3% and 85.4% (12 months), and 86.6% and 76.8% (24 months). Delayed graft function occurred in 44.6%. S-creatinine at 12 months was 1.85 ± 0.94 mg/dl. Thirty patients (53.6%) showed biopsy-proven rejections (6x Banff 3, 13x Banff 4I and 16x Banff 4II), 77% of which were steroid-sensitive, 23% required antibody treatment. After 12 months, 83% of the patients had an MMF-based immunosuppression, 43% were CNI-free. Cytomegalovirus (CMV) infections occurred in 28, tissue-invasive disease in three patients. Despite acceptable renal graft survival and function in some of patients with marginal organs, high incidences of rejections and CMV infections suggest the feasibility of CNI-avoidance using an MMF-based protocol only in carefully selected patients.