%0 Journal Article
%T Efficacy and Safety of the Intra-operative High-dose Induction with ATG-Fresenius in Older Kidney Graft Recipients
%A J. Kaden
%A G. May
%A A. V£¿lp
%A C. Wesslau
%J Transplantationsmedizin
%D 2011
%I Pabst Science Publishers
%X Aim/Background: With respect to the immunosuppressive treatment of older kidney graft recipients no unique recommendations are available or generally accepted. At our centre we developed a renal sparing regimen which combined the highly efficacious intra-operative single high-dose induction using ATG-Fresenius (9 mg/kg body weight) with a low cyclosporine trough level throughout the first post-operative week (median: 162 ng/ml; n=518 recipients). The results of a retrospective analysis comparing the long-term outcomes in older and in younger recipients showed the efficacy and safety of this treatment protocol.Material/Methods: In order to stronger underline the age difference, two clearly defined different patient cohorts were analysed: cohort 1: n=40 recipients ¡Ý 60 years; cohort 2: n=205 recipients aged between 20 to 40 years. All patients received the same basic immunosuppression consisting of CsA, azathioprine and steroids and an intra-operative single high dose ATG-F. There were no systematic differences in donor characteristics with respect to age, sex, cold ischemia time and HLA-mismatches. The recipients¡¯ characteristics were also comparable except for age (mean 63¡À2.7 vs 31.6¡À5.3 years).Results: The patient survival (censored at 120 months) was significantly longer in younger than in older recipients (mean: 109.6 vs 87.4 months; 95% confidence interval: 105.4-113.8 vs 72.2-102.6 months; p<0.001), long-term death censored graft survival did not reach statistical significance (p=0.067). The incidence of death censored graft loss within 10 years was lower in the older recipients (4/40 vs 56/205, p=0.02), but a higher proportion of death with functioning graft (11/40 vs 11/205) was noted. The rates of biopsy confirmed rejections of any type were comparable (10/40 vs 69/205), just as were the rates of malignancies (0/40 vs 1/205), PTLD (0/40 vs 1/205), CMV diseases (9/40 vs 40/205) and viral pneumonias (2/40 vs 2/205). Bacterial pneumonias were more frequent in older recipients (3/40 vs 2/205, p=0.008). Using the same initial cyclosporine dose in both cohorts a higher blood trough level was observed in the older cohort (median: 211 vs 141 ng/ml, p=0.001) during the first post-operative week indicating that older recipients may need initial lower cyclosporine doses than younger recipients in order to achieve comparable target levels. Conclusions: In older kidney graft recipients with age 60 and above receiving the intra-operative single high-dose induction with ATG combined with a basic triple-drug immunosuppression, survival and a safety profile com
%K kidney transplantation
%K immunosuppression
%K older recipients
%K induction
%K ATG-Fresenius
%K intra-operative high-dose induction
%K cyclosporine
%U http://www.transplantation.de/fileadmin/transplantation/txmedizin/txmedizin_2011_3/12_kaden.pdf