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Neuböck, M.
Retrospective evaluation of the rate of infectious complications in recipients of expanded-criteria donor kidney transplants
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp. 85 [OPEN ACCESS]


Authors Med Uni Graz:
Eller Kathrin
Kirsch Alexander

Background: An increasing demand for renal allografts has led to the use of kidneys from expanded criteria cadaveric donors (i.e. donors >60 years; or 50-59 years and creatinine > 1.5mg/dL or hypertension or death from cerebrovascular accident). These older grafts are thought to be more susceptible to nephrotoxic effects of calcineurin inhibitors (CNI). Therefore, at our center, starting in September 2014, recipients of ECD allografts received induction therapy with anti-thymocyte globulin (ATG), while targeting lower CNI through levels. This study evaluated recipients in whom this strategy was employed and compared them to prior recipients who received standard immunosuppression (IL-2RA) using anti-IL-2 receptor antibodies. Recipients of allografts from non-heart beating donors were included. Rates of hospitalisations and infectious complications were compared Material and methods: Recipients of ECD allografts were identified and clinical as well as laboratory parameters extracted from electronic medical records. Major infections were defined as infections requiring hospitalisation. The follow-up period was one year after transplantation. Results: Twenty recipients (mean age 54±11 years, n male/female 18/2, mean dialysis vintage 37±21 months) were identified in the IL-2RA group and compared to twenty recipients (mean age 57±10 years, n male/female 9/11, mean dialysis vintage months 44±40) in the ATG group. There were no significant differences between donors in the IL-2RA (mean age 58±12 years, last creatinine 0,8±0,25 mg/dL, hypertension 35%, cerebrovascular cause of death [CVA] 80%) and the ATG (mean age 63±7 years, last creatinine 0,76±0,17 mg/dL, hypertension 40%, CVA 65%) group. FK506 through levels after three (10,5±8,96 vs. 6,6±3,23 ng/mL; p<0,05) but IL-2RA seven days (8,1±2,21 vs. 7,86±3,86 ng/mL; p=0,25) were significantly higher in IL-2RA compared to ATG patients. A total of 13 patients (6 (30%) in IL-2RA group, 7 (35%) in ATG group) required hospitalisation during the follow-up, 1 patient (5%) of IL-2RA group suffered from 2 major infections. During the first month after transplantation IL-2RA group showed no hospitalisations, while 1 patient (5%) of ATG group was hospitalised. Between month 2 and 6 post transplantation 5 patients (3 (15%) in the IL-2RA group, 2 (10%) in the ATG group) suffered from a major infection. There was no difference in major infection rates during the time between month 7 and 12 of the follow-up with 8 patients (4 (20%) in IL-2RA group as well as 4 patients (20%) in ATG group) being hospitalised. Conclusions: This study shows that when comparing recipients of ECD renal allografts who were induced using IL-2RA compared to ATG there was no difference in the rate of major infections. Importantly, while early CNI through levels were significantly lower in ATG-induced patients, there was no difference in rates of delayed graft function or long-term graft function. To make any firm recommendations these data would have to be expanded and more patients would have to be included in the analysis.

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