CLINICAL IMMUNOSUPPRESSION - KIDNEY LATE

E. Stolyarevich
, Resecarh Institute of Transplantology and Artificial Organs, Moscow/RUSSIAN FEDERATION

Body: Introduction: Tacrolimus (Tac) has been used for rescuing of renal allografts from refractory rejection that occurred during treatment with conventional cyclosporine A (CyA) mostly in the earlyposttransplant period. Less is known about effect of Tac in cases of late acute rejection. Here we report our experience of Tac rescue therapy in patients with late acute rejections which occurred 3month after transplantation or later.
Aim of the study was to examine the long-term effects of switching from CyA-based therapy to Tac-based therapy versus continuation of CyA in renal transplant patients with late acute rejection.
Methods: In this comparative prospective clinical study 128 patients (median age 33 years; range 16 to 67 years; 74 males, 54 females) experiencing a late biopsy-proven acute rejection werefollowed-up for up to 1 year. The median rejection time was 35.1 months (range 3 to 101 months) after transplantation. 44 patients were converted from a CуA- based therapy to the Tac one; in 84 patients CsA-based therapy was continued. Acute rejection episodes were treated with intravenous methylprednisolone (ME) pulses (0.5 g on three consecutive days). Switch to Tac was undertakenat an initial dose of 0.15 mg/kg/d, which was subsequently adjusted to maintain Tac blood trough levels between 5 and 10 ng/ml. Cyclosporine whole blood level was maintained in the range of 150 to200 ng/mL. Rejection diagnosis was based on the strict Banff criteria. The incidence of graft loss, treatment failure, and death were analysed using Kaplan-Meier methods. Comparisons between the twogroups were made using Mann-Whitney and Wilcoxon tests. Baseline clinical and pathological characteristics were comparable for both groups. The 1-year Kaplan-Meier estimates for graft loss were 84.2%(Tac) and 63.2% (CyA-ME), respectively (P=0.01). During the first month after the rejection episode the median serum creatinine concentration had decreased in both groups (from 0.29 to 0.26 mmol/l inthe CsA group and from 0.25 to 0.19 mmol/lin the Tac group (see Table) In a year after graft function remained stable in the Tac group (0,17 (0,14;0,27) mmol/l), while in the CsA group a trend toprogression of graft failure was observed (0.3(0.2;0.8) mmol/l).

Disclosure: All authors have declared no conflicts of interest.