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37 Prevention of Early Acute Rejection with Daclizumab and Triple Immunosuppression in Cadaveric Renal Allograft Recipients
Author(s) -
Kandus A,
Grego K,
Arnol M,
Kovač D,
Kovač J,
Lindič J,
Bren A F
Publication year - 2005
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1526-0968.2005.222_37_37.x
Subject(s) - daclizumab , medicine , immunosuppression , methylprednisolone , transplantation , urology , surgery , renal function , gastroenterology , tacrolimus
We assessed the safety and efficacy of daclizumab combined with triple immunosuppression in adult recipients of at least 1 HLA‐mismatched cadaveric renal allograft. All studied patients received equal immunosuppression: daclizumab infusion of 1 mg/kg immediately before transplantation and at 2, 4, 6 and 8 weeks following the transplantation, infusion of cyclosporine (CyA) (0.08 mg/kg/hr) started at operation and continued by CyA‐Neoral, 3 mg/kg b.i.d. on day 2, methylprednisolone, 0.4 mg/kg i.v. at operation, and mycophenolate mofetil started on day 1. CyA‐Neoral dose was adjusted to maintain blood trough levels of 100–170 ng/mL (FPIA, monoclonal). Oral methylprednisolone was tapered by 4 mg per week to achieve maintenance dose of 0.08 mg/kg/day. 39 patients, with mean age of 49 ± 10 years (SD; range 26–66 years), were studied. Three of them received a second renal allograft. The mean donor age was 38 ± 13 years (range 16–58 years). Mean cold ischemia time was 19.0 ± 6.5 h (range 9.5–39.5 h), mean value of HLA‐antigen mismatches was 2.7 ± 1.0 (range 1–5), mean latest PRA value was 3 ± 8% (range 0–47%). Ten patients experienced delayed graft function. During follow‐up of 3 months one acute rejection episode was observed, vascular type, treated with OKT3. One patient experienced a hypersensitivity reaction to daclizumab, which despite precautionary measures required early interruption of the 5th infusion dose. In two patients CMV disease, requiring hospitalisation, was successfully treated. No malignancies were detected. After 3 months mean serum creatinine was 102.2 ± 24.0 µmol/L (range 63–152 µmol/L). 2 renal allografts were removed, but not for rejection. Patient and graft survival was 100% and 94.9%, respectively. We conclude that daclizumab with this triple therapy represents a safe and efficient immunosuppression strategy, demonstrated with low incidence of early acute rejection episodes, excellent allograft function, acceptable adverse event profile and high short‐term survival rate.