Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients
Abstract Background The efficacy and safety of minimisation of immunosuppression including early steroid withdrawal in kidney transplant recipients treated with Basiliximab induction remains unclear. Methods This retrospective cohort study reports the outcomes from 298 consecutive renal transplants...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Nephrology |
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| Online Access: | http://link.springer.com/article/10.1186/s12882-020-01739-3 |
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| author | Mysore K. Phanish Richard P. Hull Peter A. Andrews Joyce Popoola Edward J. Kingdon Iain A. M. MacPhee for the South West Thames Renal Transplantation Network |
| author_facet | Mysore K. Phanish Richard P. Hull Peter A. Andrews Joyce Popoola Edward J. Kingdon Iain A. M. MacPhee for the South West Thames Renal Transplantation Network |
| author_sort | Mysore K. Phanish |
| collection | DOAJ |
| description | Abstract Background The efficacy and safety of minimisation of immunosuppression including early steroid withdrawal in kidney transplant recipients treated with Basiliximab induction remains unclear. Methods This retrospective cohort study reports the outcomes from 298 consecutive renal transplants performed since 1st July 2010–June 2013 treated with Basiliximab induction and early steroid withdrawal in low immunological risk patients using a simple immunological risk stratification and 3-month protocol biopsy to optimise therapy. The cohort comprised 225 low-risk patients (first transplant or HLA antibody calculated reaction frequency (CRF ≤50% with no donor specific HLA antibodies) who underwent basiliximab induction, steroid withdrawal on day 7 and maintenance with tacrolimus and mycophenolate mofetil (MMF), and 73 high-risk patients who received tacrolimus, MMF and prednisolone for the first 3 months followed by long term maintenance immunosuppression with tacrolimus and prednisolone. High-risk patients not undergoing 3-month protocol biopsy were continued on triple immunosuppression. Results Steroid withdrawal could be safely achieved in low immunological risk recipients with IL2 receptor antibody induction. The incidence of biopsy-proven acute rejection was 15.1% in the low-risk and 13.9% in the high-risk group (including sub-clinical rejection detected at protocol biopsy). One- year graft survival was 93.3% and patient survival 98.5% in the low-risk group, and 97.3 and 100% respectively in the high-risk group. Graft function was similar in each group at 1 year (mean eGFR 61.2 ± 23.4 mL/min low-risk and 64.6 ± 19.2 mL/min high-risk). Conclusions Immunosuppression regimen comprising basiliximab induction, tacrolimus, MMF and prednisolone with early steroid withdrawal in low risk patients and MMF withdrawal in high risk patients following a normal 3-month protocol biopsy is effective in limiting acute rejection episodes and produces excellent rates of patient survival, graft function and complications. |
| first_indexed | 2024-04-13T03:02:16Z |
| format | Article |
| id | doaj.art-478e781b000d4eefbb2646194e059a2d |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-13T03:02:16Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-478e781b000d4eefbb2646194e059a2d2022-12-22T03:05:23ZengBMCBMC Nephrology1471-23692020-03-0121111110.1186/s12882-020-01739-3Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipientsMysore K. Phanish0Richard P. Hull1Peter A. Andrews2Joyce Popoola3Edward J. Kingdon4Iain A. M. MacPhee5for the South West Thames Renal Transplantation NetworkSouth West Thames Renal and Transplantation Unit, St Helier Hospital, Epsom and St Helier University Hospitals NHS trustRenal Unit, King’s College Hospitals NHS Foundation TrustRenal Unit, Epsom and St Helier University Hospitals NHS TrustRenal Medicine and Transplantation, St George’s University Hospitals NHS Foundation TrustSussex Kidney Unit, Brighton and Sussex University Hospitals NHS TrustRenal Medicine and Transplantation, St George’s University Hospitals NHS Foundation TrustAbstract Background The efficacy and safety of minimisation of immunosuppression including early steroid withdrawal in kidney transplant recipients treated with Basiliximab induction remains unclear. Methods This retrospective cohort study reports the outcomes from 298 consecutive renal transplants performed since 1st July 2010–June 2013 treated with Basiliximab induction and early steroid withdrawal in low immunological risk patients using a simple immunological risk stratification and 3-month protocol biopsy to optimise therapy. The cohort comprised 225 low-risk patients (first transplant or HLA antibody calculated reaction frequency (CRF ≤50% with no donor specific HLA antibodies) who underwent basiliximab induction, steroid withdrawal on day 7 and maintenance with tacrolimus and mycophenolate mofetil (MMF), and 73 high-risk patients who received tacrolimus, MMF and prednisolone for the first 3 months followed by long term maintenance immunosuppression with tacrolimus and prednisolone. High-risk patients not undergoing 3-month protocol biopsy were continued on triple immunosuppression. Results Steroid withdrawal could be safely achieved in low immunological risk recipients with IL2 receptor antibody induction. The incidence of biopsy-proven acute rejection was 15.1% in the low-risk and 13.9% in the high-risk group (including sub-clinical rejection detected at protocol biopsy). One- year graft survival was 93.3% and patient survival 98.5% in the low-risk group, and 97.3 and 100% respectively in the high-risk group. Graft function was similar in each group at 1 year (mean eGFR 61.2 ± 23.4 mL/min low-risk and 64.6 ± 19.2 mL/min high-risk). Conclusions Immunosuppression regimen comprising basiliximab induction, tacrolimus, MMF and prednisolone with early steroid withdrawal in low risk patients and MMF withdrawal in high risk patients following a normal 3-month protocol biopsy is effective in limiting acute rejection episodes and produces excellent rates of patient survival, graft function and complications.http://link.springer.com/article/10.1186/s12882-020-01739-3Corticosteroid-withdrawalBasiliximabMycophenolate mofetilRenal transplantationTacrolimus |
| spellingShingle | Mysore K. Phanish Richard P. Hull Peter A. Andrews Joyce Popoola Edward J. Kingdon Iain A. M. MacPhee for the South West Thames Renal Transplantation Network Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients BMC Nephrology Corticosteroid-withdrawal Basiliximab Mycophenolate mofetil Renal transplantation Tacrolimus |
| title | Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients |
| title_full | Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients |
| title_fullStr | Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients |
| title_full_unstemmed | Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients |
| title_short | Immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients |
| title_sort | immunological risk stratification and tailored minimisation of immunosuppression in renal transplant recipients |
| topic | Corticosteroid-withdrawal Basiliximab Mycophenolate mofetil Renal transplantation Tacrolimus |
| url | http://link.springer.com/article/10.1186/s12882-020-01739-3 |
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