De novo mTOR inhibitor‐based immunosuppression in ABO‐incompatible kidney transplantation. (5th October 2015)

• Record Type: Journal Article
• Authors: Koch, Martina; Wiech, Thorsten; Marget, Matthias; Peine, Sven; Thude, Hansjörg; Achilles, Eike G.; Fischer, Lutz; Lehnhardt, Anja; Thaiss, Friedrich; Nashan, Bjoern
• Is Part Of: Clinical transplantation. Volume 29:Number 11(2015)
• Page Start: 1021
• Page End: 1028
• Publication Date: 2015-10-05
• Subjects: ABO‐incompatible kidney transplantation -- CMV -- immunosuppression -- mTOR inhibitor; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.12624
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: ABO‐incompatible (ABO i ) kidney transplantation (KTx) 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 KTx 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 KTx with a de novo mTOR inhibitor‐based regimen is feasible without severe surgical or immunological complications and a low rate of viral infections.