CLINICAL IMMUNOSUPPRESSION - KIDNEY EARLY

A. Sharshatkin¹, O. Azarenkova¹, N. Pulkova¹, I. Myloserdov¹, Y. Solomina¹, Y. Moysyuk^2
1Kidney And Liver Transplantation, Research Institute for Transplantation and Artificial Organs, Moscow/RUSSIAN FEDERATION, ²Pathology, 1Federal Scientific Center of Transplantology and Artificial organs, Moscow/RUSSIAN FEDERATION

Body: Introduction: The number of cadaveric kidney transplantations in Russia remains at the low level of 4,5 operations per million while thewaiting list is constantly increasing. For many patients with an end stage of renal failure the period of expectation of transplantation is very long. It is well-known that living kidneytransplantations both related and unrelated have better results than cadaveric transplantations therefore about 18% of all kidney transplantations in our country are living-related (LR). To expandthe pool of organ donors our institute has developed the program of living kidney donation and the percentage of LR kidney transplants in our center exceeds 40%. Calcineurin inhibitors (CNIs) stillremain the mainstay in current immunosuppressive therapy in kidney transplantation. Since 2006 we have started to use tacrolimus in the triple immunosuppressive regimen based on steroids andmycophenolates with basiliximab induction. The aim of this study was to compare the efficiency of cyclosporine A and tacrolimus during the first years after LR kidney transplantations.Methods: Between January 2006 and December 2009, a total of 133 living-related kidneys have been transplanted of whom 104 were on cyclosporine A treatment (CsA group) and 29 ontacrolimus (Tac group). There were no differences in donor and patient age, cause of kidney disease, cold ischemia time and other demographic and clinical characteristics between groups. Meanfollow-up was 2.3±1.1 years. Results: Delayed graft function caused by acute tubular necrosis was equal in CsA and Tac groups and occurred in 7,5% cases. During the first 3months after transplantation, 18 episodes of acute rejection have been registered in CsA group (17,3%, all were biopsy proved), one kidney graft has been lost due to hyperacute rejection. There were6 (20,6%) cases of acute rejection in Tac group (n.s.). One kidney graft in Tac group has been recognized as primary nonfunctioning and one has been lost because of recurrent membranoproliferativeglomerulonephritis. A 1- and 3-year graft survival according to the Kaplan-Meier method in CsA group was 99,0% and 96,0%, in Tac group 96,2% and 96,2%, respectively (p=0,22).Conclusion: Despite low incidence of delayed graft function LR kidney transplantation does not exclude the probability of acute rejection. Our data indicate that both CsA and Tacbased immunosuppressive regimens provide similar excellent renal outcome in recipients during the first years after LR kidney transplantation. The choice of CNIs should be individual and depends onrecipient features including intensity of side effects.

Disclosure: All authors have declared no conflicts of interest.