National Congress of the Spanish Society of TransplantationRenal transplantationUsefulness of Delayed Introduction of Tacrolimus in Kidney Transplants Using Type-III Donors After Circulatory Death
Section snippets
Material and Methods
All kidney transplants performed using type-III DCD in our hospital (42) were retrospectively analyzed, with a follow-up of 6 months. The transplants were classified according to the initial immunosuppression in 2 groups: a first group (28 transplants), from 2014 until July 2016, with thymoglobulin (cumulative dose of 5–7 mg/kg) + delayed TAC (3°-4° day) and a second group (13 transplants), from August 2016 to 2017, with basiliximab (20 mg on day 0 and 4) + initial TAC. In both groups, low
Results
Demographic data of both populations were comparable, as shown in Table 1. The evolution of creatinine at days 3, 7, 14, 30, and 180 (excluding those who required dialysis in the first days) was 4.05 ± 2.5, 2.27 ± 1.7, 2.09 ± 1.3, 1.49 ± 0.7, and 1.45 ± 0.49 mg/dL for group 1 and 3.15 ± 1.5, 2.08 ± 1.3, 2.07 ± 1.3, 1.73 ± 1.2, and 1.6 ± 0.8 mg/dL for group 2 (pNS). Proteinuria at 6 months was 462.75 ± 417.11 in group 1 and 350.83 ± 190.27 mg/24 hours in group 2 (pNS). Tacrolimus levels measured
Discussion
Kidneys from donors after circulatory death suffer a more intense ischemic damage due to the period of absence of blood flow before cold perfusion, and this effect is responsible for a considerably higher rate of DGF after transplant [4], [5], [11]. This is especially relevant in type-II DCD where circulatory cessation can be extremely long and as many as 70% or more cases develop DGF. Nevertheless, the cases of type-III DCD are not comparable. In these cases of “controlled” DCD, the period of
Acknowledgments
This study was carried out in collaboration with the group of IDIVAL-Hospital Universitario Marqués de Valdecilla and REDINREN RD16/0009/0027. Instituto de Salud Carlos III. Ministerio de economía y competitividad.
References (11)
- et al.
Immunosuppression in the elderly renal allograft recipient: a systematic review
Transplant Rev
(2016) - et al.
Donation after circulatory death and its expansion in Spain
Curr Opin Organ Transplant
(2018) - et al.
Primary immunosuppression with mycophenolate mofetil and antithymocyte globulin for kidney transplant recipients of a suboptimal graft
Nephrol Dial Transplant
(1998) - et al.
Preferential allocation of marginal kidney allografts to elderly recipients combined with modified immunosuppression gives good results
Transplantation
(2005) - et al.
Use of different immunosuppressive strategies in recipients of kidneys from nonheart-beating donors
Transpl Int
(2005)
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