CLINICAL IMMUNOSUPPRESSION - KIDNEY LATE

K.H. Huh¹, Y.S. Kim², J.J. Lee¹, M.S. Kim², S.I. Kim², K. Park^3
1Surgery, Yonsei university college of medicine, Seoul/KOREA, ², Yonsei university college of medicine, Seoul/KOREA, ³, CHA Bundang Medical Center, Seongnam/KOREA

Body: Introduction: Type of maintenance immunosuppressive regimen (ISR) is a major prognostic factor that determines graft survival. Therefore, a change or modulation of the ISR may be a potential determinant that affect the transplant results. This study evaluates the effects of change or modulation of ISR on long-term transplant results. Methods: A total of 1,164 patients that underwent kidney transplantation from January, 1997 to December, 2008 in Yonsei University Health System were enrolled in this study. The change mode of immunosuppressant, the reason for change, and the transplant results were retrospectively collected. Results: Among 1,164 kidney transplant recipients, 201 recipients (17.3%) were started under the double regimen (DR) (calcineurin inhibitor (CNI) and steroid) and 963 recipients (82.7%) were under triple regimen (TR) (CNI+steroid+antimetabolite). Seventy-seven recipient (38.3%) with DR and 271 recipients (28.1%) with TR were changed ISR during post-transplant period. Among the recipient with DR, the most frequent reason for regimen change was acute rejection in early post-transplant period and chronic allograft dysfunction in late period. Conversion to TR (69/201, 34.3%) was predominant change mode of recipient with initial DR. Unlike recipient with DR, major causes of regimen change in recipients with TR were complications related with over-immunosuppression and drug toxicity regardless of post-transplant period. Conversion to DR and change of antimetabolite were performed in 127 recipients (127/ 963, 12.6%) and 98 recipient (98/963, 10.2%) respectively. The change group of initial DR showed statistically superior graft survival rate (GSR) (p=0.032) compared with maintain group of initial DR. On the other hand, the change group of initial TR showed inferior GSR (p<0.001). [Figure] Conclusion: The cause and mode of regimen change was clearly different by type of initial regimen. And effect of regimen change on transplant result was also different. The type of regimen after post-transplant change or modulation affects the long-term transplant result. The triple maintain regimen with antimetabolite showed a superior GSR.

Disclosure: All authors have declared no conflicts of interest.