LOW DOSE ATG INDUCTION FOR OLDER KIDNEY TRANSPLANT RECIPIENTS (OLD FOR OLD); SINGLE CENTRE EXPERIENCE OVER 4 YEARS.

INDUCTION IMMUNOSUPPRESSION

G. Block¹, M. Meier¹, J. Steinhoff¹, C.B. Buerk², M. Nitschke^3
1Devision Of Nephrology And Transplantation, University of Luebeck, Lübeck/GERMANY, ²Devision Of Transplantation, University of Luebeck, Lübeck/GERMANY, ³Devision Of Nephrology And Transplantation, University of Lübeck, Lübeck/GERMANY

Body: Introduction: There is increasing evidence that older kidney transplant recipients who receive an organ from an old donor (old for old or ESP transplantation in the Eurotransplant region) have an potent early immune response possibly leading to an increased number of rejection episodes. On the other hand risk of lymphoma due to induction therapy is small as residual life expectancy in this kidney transplant recipients is limited. Therefore we started in 2006 with a low dose ATG induction protocol for our older kidney transplant recipients. Here we present preliminary data on graft function and patient survival in comparison to patients of the same time period who were transplanted after living donation (LD) or the regular Eurotransplant allocation program (ETKAS). Methods: Between January 2006 and December 2009 we have done 306 kidney transplantations at our centre: 58 (9 %) ESP, 76 (25%) after LD transplantation and 172 (56 %) after ETKAS allocation. Seven of the LD transplantations have been AB0 incompatible. The induction protocol utilized 3.5 mg / kg body weight ATG (Thymoglobulin) divided in two doses on day 1 and 2, cyclosporine 3 mg/kg body weight per day, mycofenolat mofetil 1000 mg bid and methylprednisolon (500 mg – 250 mg – 125 mg, day 1-3, 20 mg qd subsequently reduced to 6 mg qd). Results:

	ESP n=58	ETKAS n=172	LD n=76
recipient age	67	48	46
donor age	70	47	51
cold ischemia time (hrs)	7,63	14,06	1,47
mismatch	4,5	2	3,4
hospital stay (days)	22	21	24
rejection (%)	19	17	28
creatinine(µmol/l)	174	157	144
deleyed graft func. (%)	34	34	11
primary nonfunction (%)	7	6	1
infection rate (%)	14	2	9
graft survival (%)*	71	91	97
patient survival (%)*	84	93	100

⁾ at discharge, * at latest follow up Conclusion: Conclusion: Old for old transplantation utilizing a low-dose ATG induction protocol is safe and successful regarding patient and graft survival and function at least in the short term follow up period.

Disclosure: All authors have declared no conflicts of interest.