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A calcineurin antagonist‐free induction/maintenance strategy for immunosuppression in elderly recipients of renal allografts from elderly cadaver donors: long‐term results from a prospective single centre trial *
Author(s) -
Arbogast Helmut,
Hückelheim Henning,
Schneeberger Helmut,
Illner WolfD,
Tarabichi Anwar,
Fertmann Jan,
Wimmer Cosmas D,
Hillebrand Günter F,
MistryBurchardi Nouhad,
Thomae Robert,
Acikgöz Ali,
Land Walter
Publication year - 2005
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/j.1399-0012.2005.00309.x
Subject(s) - medicine , mycophenolic acid , calcineurin , immunosuppression , transplantation , surgery , creatinine , urology , nephrotoxicity , regimen , renal function , prospective cohort study , kidney
Background: With the aim to improve the inferior outcomes in elderly recipients of kidneys from elderly cadaver donors, we applied and investigated a therapeutic regimen consisting of calcineurin inhibitor (CNI)‐free, mycophenolate mofetil (MMF)‐based immunosuppressive (i.s.) induction/maintenance protocol. In this article, we report the long‐term results of this clinical trial. Methods: A total of 89 recipients (mean age: 63.8 yr) of kidneys from cadaver donors (mean age: 66.8 yr) were consecutively recruited for this 5‐yr, prospective, open, single centre, pilot trial. Induction therapy consisted of MMF and steroids in conjunction with a short course (4–10 d) of rabbit antithymocyte globulin (ATG). Maintenance treatment was performed with MMF/steroids or MMF alone under strict therapeutic drug monitoring by aiming target mycophenolic acid (MPA)‐trough levels between 2 and 6 mg/mL. Results: Cumulative 5‐year patient and renal allograft survival was 87.69% and 69.81%, respectively. Acute rejection episodes occurred in 23.6% (21 patients). Long‐term function of the old renal allografts proved to be satisfactory as reflected by serum creatinine‐values of 1.53 mg/dL and urea‐values of 57.9 mg/dL at 5 yr. Conclusion: Application of a nephrotoxicity‐ and atherogenicity‐free, MMF‐based i.s. induction/maintenance protocol in elderly recipient of kidneys from elderly cadaver donors leads to improved long‐term outcomes which are comparable with data from young recipients who have received allografts from young cadaver donors.