Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients.
Adult
Aged
Azathioprine
/ administration & dosage
Basiliximab
/ administration & dosage
Drug Administration Schedule
Female
Glucocorticoids
/ administration & dosage
Graft Rejection
/ immunology
Graft Survival
/ immunology
Humans
Immunosuppressive Agents
/ administration & dosage
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Mycophenolic Acid
/ administration & dosage
Opportunistic Infections
/ diagnosis
Postoperative Care
/ methods
Postoperative Complications
/ diagnosis
Prednisolone
/ administration & dosage
Receptors, Interleukin-2
/ antagonists & inhibitors
Renal Insufficiency, Chronic
/ surgery
Retrospective Studies
Risk Assessment
Tacrolimus
/ administration & dosage
Young Adult
Basiliximab
Corticosteroid-withdrawal
Mycophenolate mofetil
Renal transplantation
Tacrolimus
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
11 03 2020
11 03 2020
Historique:
received:
04
12
2018
accepted:
25
02
2020
entrez:
13
3
2020
pubmed:
13
3
2020
medline:
22
6
2021
Statut:
epublish
Résumé
The efficacy and safety of minimisation of immunosuppression including early steroid withdrawal in kidney transplant recipients treated with Basiliximab induction remains unclear. This retrospective cohort study reports the outcomes from 298 consecutive renal transplants performed since 1st July 2010-June 2013 treated with Basiliximab induction and early steroid withdrawal in low immunological risk patients using a simple immunological risk stratification and 3-month protocol biopsy to optimise therapy. The cohort comprised 225 low-risk patients (first transplant or HLA antibody calculated reaction frequency (CRF ≤50% with no donor specific HLA antibodies) who underwent basiliximab induction, steroid withdrawal on day 7 and maintenance with tacrolimus and mycophenolate mofetil (MMF), and 73 high-risk patients who received tacrolimus, MMF and prednisolone for the first 3 months followed by long term maintenance immunosuppression with tacrolimus and prednisolone. High-risk patients not undergoing 3-month protocol biopsy were continued on triple immunosuppression. Steroid withdrawal could be safely achieved in low immunological risk recipients with IL2 receptor antibody induction. The incidence of biopsy-proven acute rejection was 15.1% in the low-risk and 13.9% in the high-risk group (including sub-clinical rejection detected at protocol biopsy). One- year graft survival was 93.3% and patient survival 98.5% in the low-risk group, and 97.3 and 100% respectively in the high-risk group. Graft function was similar in each group at 1 year (mean eGFR 61.2 ± 23.4 mL/min low-risk and 64.6 ± 19.2 mL/min high-risk). Immunosuppression regimen comprising basiliximab induction, tacrolimus, MMF and prednisolone with early steroid withdrawal in low risk patients and MMF withdrawal in high risk patients following a normal 3-month protocol biopsy is effective in limiting acute rejection episodes and produces excellent rates of patient survival, graft function and complications.
Sections du résumé
BACKGROUND
The efficacy and safety of minimisation of immunosuppression including early steroid withdrawal in kidney transplant recipients treated with Basiliximab induction remains unclear.
METHODS
This retrospective cohort study reports the outcomes from 298 consecutive renal transplants performed since 1st July 2010-June 2013 treated with Basiliximab induction and early steroid withdrawal in low immunological risk patients using a simple immunological risk stratification and 3-month protocol biopsy to optimise therapy. The cohort comprised 225 low-risk patients (first transplant or HLA antibody calculated reaction frequency (CRF ≤50% with no donor specific HLA antibodies) who underwent basiliximab induction, steroid withdrawal on day 7 and maintenance with tacrolimus and mycophenolate mofetil (MMF), and 73 high-risk patients who received tacrolimus, MMF and prednisolone for the first 3 months followed by long term maintenance immunosuppression with tacrolimus and prednisolone. High-risk patients not undergoing 3-month protocol biopsy were continued on triple immunosuppression.
RESULTS
Steroid withdrawal could be safely achieved in low immunological risk recipients with IL2 receptor antibody induction. The incidence of biopsy-proven acute rejection was 15.1% in the low-risk and 13.9% in the high-risk group (including sub-clinical rejection detected at protocol biopsy). One- year graft survival was 93.3% and patient survival 98.5% in the low-risk group, and 97.3 and 100% respectively in the high-risk group. Graft function was similar in each group at 1 year (mean eGFR 61.2 ± 23.4 mL/min low-risk and 64.6 ± 19.2 mL/min high-risk).
CONCLUSIONS
Immunosuppression regimen comprising basiliximab induction, tacrolimus, MMF and prednisolone with early steroid withdrawal in low risk patients and MMF withdrawal in high risk patients following a normal 3-month protocol biopsy is effective in limiting acute rejection episodes and produces excellent rates of patient survival, graft function and complications.
Identifiants
pubmed: 32160893
doi: 10.1186/s12882-020-01739-3
pii: 10.1186/s12882-020-01739-3
pmc: PMC7065371
doi:
Substances chimiques
Glucocorticoids
0
Immunosuppressive Agents
0
Receptors, Interleukin-2
0
Basiliximab
9927MT646M
Prednisolone
9PHQ9Y1OLM
Mycophenolic Acid
HU9DX48N0T
Azathioprine
MRK240IY2L
Tacrolimus
WM0HAQ4WNM
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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