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De novo m TOR inhibitor‐based immunosuppression in ABO ‐incompatible kidney transplantation
Author(s) -
Koch Martina,
Wiech Thorsten,
Marget Matthias,
Peine Sven,
Thude Hansjörg,
Achilles Eike G.,
Fischer Lutz,
Lehnhardt Anja,
Thaiss Friedrich,
Nashan Bjoern
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12624
Subject(s) - medicine , immunosuppression , calcineurin , everolimus , regimen , tacrolimus , rituximab , abo blood group system , kidney transplantation , basiliximab , mycophenolic acid , transplantation , sirolimus , gastroenterology , allotransplantation , bk virus , immunology , urology , antibody
ABO ‐incompatible ( ABO i ) kidney transplantation ( KT x) has become an accepted therapeutic option in renal replacement therapy for patients without a blood group‐compatible living donor. Using different desensitization strategies, most centers apply B‐cell depletion with rituximab and maintenance immunosuppression ( IS ) with tacrolimus and mycophenolic acid. This high load of total IS leads to an increased rate of surgical complications and virus infections in ABO i patients. Our aim was to establish ABO i KT x using an immunosuppressive regimen, which is effective in preventing acute rejection without increasing the risk for viral infections. Therefore, we selected a de novo immunosuppressive protocol with low‐dose calcineurin inhibitor and the mTOR inhibitor everolimus for our ABO i program. Here, we report the first 25 patients with a complete three‐yr follow‐up treated with this regimen. Three‐yr patient survival and graft survival were 96% and 83%. The rate of acute T‐cell‐mediated rejections was low (12%). Cytomegalovirus ( CMV ) infection was evident in one patient only (4%). Surgical complications were common (40%), but mild in 80% of cases. We demonstrate that ABO i KT x with a de novo m TOR inhibitor‐based regimen is feasible without severe surgical or immunological complications and a low rate of viral infections.