An mTOR-inhibitor-based protocol and calcineurin inhibitor (CNI)-free treatment in kidney transplant recipients from donors after cardiac death: good renal function, but high incidence of conversion to CNI

作者：Sanchez Escuredo Ana; Diekmann Fritz^*; Revuelta Ignacio; Esforzado Nuria; Jose Ricart Maria; Cofan Frederic; Torregrosa Jose Vicente; Peri Lluis; Ruiz Angel; Maria Campistol Josep; Oppenheimer Federico

来源：Transplant International, 2016, 29(3): 362-368.

DOI：10.1111/tri.12732

• calcineurin inhibitor
• conversion
• donors after cardiac death
• mammalian target of rapamycin inhibitor

Donor after cardiac death (DCD) grafts have excellent survival despite the high incidence of delayed graft DGF). We assessed the feasibility of a mammalian target of rapamycin inhibitor (mTOR-I) protocol in uncontrolled DCD kidney transplantation and compared it with brain-dead donor (DBD) transplantation under calcineurin inhibitor (CNI) treatment. This retrospective study (2002-2011) included 109 Maastricht category II DCD patients and 218 standard-criteria DBD as controls. Immunosuppression consisted of polyclonal antibody induction, mycophenolate mofetil, prednisone, and mTOR-I (starting on day 6) in the DCD group and tacrolimus in the DBD group. DGF occurred in 72.5% of the DCD group vs. 26.1% of the DBD group (P=0.001). Patient survival at 1year was 99.1% vs. 95.9% (P=0.112), and graft survival was 89% vs. 92.2% (P=0.253). Patient survival at 5years was 85.3% vs. 90.1% (P=0.340) and graft survival was 85.5% vs. 78.8% (P=0.166). During the first year, 46.8% (n=51) of DCD patients were converted to CNI therapy. Serum creatinine at 1year was 1.5(1.26-2) mg/dl vs. 1.4(1.16-1.8) mg/dl (P=0.078). At 1year, the acute rejection rate was 7.3% vs. 12.5% (P=0.766). mTOR-I-based therapy was not associated with inferior graft function or higher rejection rates than standard CNI therapy. DCD kidney transplantation with an mTOR-I-based protocol is feasible but is associated with a high conversion rate to CNI-based therapy.

• 出版日期2016-3