National Congress of the Spanish Society of Transplantation
Renal transplantation
Usefulness of Delayed Introduction of Tacrolimus in Kidney Transplants Using Type-III Donors After Circulatory Death

https://doi.org/10.1016/j.transproceed.2018.10.022Get rights and content

Abstract

Introduction

Our study compares 2 immunosuppressive strategies to reduce tacrolimus nephrotoxicity and its risk of acute tubular necrosis: delayed introduction of tacrolimus plus thymoglobulin vs initial tacrolimus plus basiliximab on the results of kidney transplant (KT) using type-III donation after circulatory death (III-DCD).

Material and methods

We analyzed all the transplants performed using type-III DCD in our hospital (42 cases). They were distributed in a first stage with delayed tacrolimus (3°-4° day) + thymoglobulin and a second one with initial tacrolimus + basiliximab, with a follow-up of 6 months. The rate of delayed graft function, the evolution of renal function, and the incidence of rejection were compared.

Results

28 patients received thymoglobulin with delayed tacrolimus, and 13 patients received basiliximab and tacrolimus from day 0 (1 excluded). There were no significant differences in delayed graft function (27% group 1 and 23% group 2) or in rejection (10.7% and 15.4%), respectively. Serum creatinine at day 3, 7, 14, 30, and 180 showed no statistically significant differences. The levels of tacrolimus measured at 10, 30, 90, and 180 days after transplantation were similar, except for the first month: 10.10 ± 2.3 in group 1 and 12 ± 1.7 ng/mL in group 2 (P = .007).

Conclusions

Delayed introduction of tacrolimus does not seem to suppose a benefit in KT using type-III DCD; therefore, the use of thymoglobulin, with its higher profile of adverse effects, seems unjustified in patients with normal immunological risk.

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.

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