The kidney transplant program at the Bergamo Center

Area of Science:

• Nephrology
• Immunology
• Transplantation Medicine

Background:

• The Ospedali Riuniti of Bergamo established its kidney transplant program in 1989.
• The program has performed 367 kidney transplants, achieving 8-year patient and graft survival rates of 94% and 77% respectively.
• Collaborations have expanded to include immunology, pharmacology, and international networks like the Double Kidney Transplant Group (DKG).

Purpose of the Study:

• To evaluate outcomes of kidney transplantation, including dual and combined organ transplants.
• To investigate immunosuppressive strategies, focusing on cyclosporine (CsA) pharmacokinetics and pharmacodynamics, and mycophenolate mofetil (MMF) in clinical trials.
• To explore the mechanisms of chronic allograft nephropathy and assess interventions for post-transplant renal artery stenosis.

Main Methods:

• Analysis of patient and graft survival data from 367 kidney transplants.
• Pharmacokinetic and pharmacodynamic studies of cyclosporine (CsA) and mycophenolate mofetil (MMF).
• Gene expression analysis of inflammatory markers in graft biopsies and assessment of percutaneous transluminal angioplasty for renal artery stenosis.

Main Results:

• Successful performance of 19 dual kidney transplants, 4 heart-kidney, and 2 liver-kidney transplants.
• Development of methods for CsA exposure evaluation and optimization of CsA dosing via calcineurin activity monitoring.
• Ongoing multicenter trial (MY.S.S.) on steroid-sparing immunosuppression with MMF, randomizing 325 patients.

Conclusions:

• The kidney transplant program demonstrates strong survival rates and has expanded to complex procedures.
• Research efforts are optimizing immunosuppression and investigating chronic allograft nephropathy.
• Interventions like angioplasty for renal artery stenosis are effective, and experimental research explores tolerance and gene therapy.