Nephrotoxizitätsfreie Immunsuppression bei älteren Empfängern von postmortal entnommenen Nieren älterer Organspender - Ergebnisse einer prospektiven Pilotstudie -

Background. With the aim to improve the inferior outcomes in
elderly recipients of kidneys from elderly cadaver donors, we
applied and investigated a therapeutic regimen consisting of
Calcineurin- inhibitor-free, mycophenolate mofetil (MMF) – based
immunosuppressive induction/maintenance protocol. In this article,
we report the long-term results of this clinical trial. Methods. 89
recipients (mean age:63,8 y) of kidneys from cadaver donors (mean
age: 66,8y) were consecutively recruited for this 5-year,
prospective, open, single centre, pilot trial. Induction therapy
consisted of MMF and steroids in conjunction with a a short course
(4-10 days) of rabbit ATG. Maintenance treatment was performed with
MMF/steroids or MMF alone under strict therapeutic drug monitoring
by aiming target MPA-trough levels between 2 – 6 mg/mL. Results.
Cumulative 5-year patient and renal allograft survival was 87,69 %
and 69,81 %, respectively. Acute rejection episodes occurred in
23,6 % (21 patients). Long-term function of the old renal
allografts proved to be satisfactory as reflected by serum
Creatinine-values of 1,53 mg/dl and Urea-values of 57,9 mg/dl at 5
years. Conclusion. Application of a nephrotoxicity- and
atherogenicity-free, MMF-based immunosuppressive
induction/maintenance protocol in elderly recipient of kidneys from
elderly cadaver donors leads to improved long-term outcomes which
are comparable with data from young recipients who have received
allografts from young cadaver donors.