Immunosuppression for dual kidney transplantation with marginal organs: the old is better yet

Area of Science:

• Nephrology
• Transplantation Immunology
• Immunosuppression

Background:

• Dual kidney transplantation (DKT) commonly uses calcineurin inhibitors (CNI) for immunosuppression.
• Optimizing immunosuppressive protocols in DKT, especially for older recipients with marginal donor organs, remains an area of research.

Purpose of the Study:

• To evaluate the efficacy of a CNI-free immunosuppressive protocol versus a standard CNI-based regimen in older patients undergoing DKT with marginal donor organs.

Main Methods:

• A comparative study involving 36 patients treated with cyclosporine (CsA), mycophenolate mofetil (MMF), and prednisone versus 42 patients treated with anti-thymocyte globulin (rATG), sirolimus (SRL), MMF, and prednisone.
• Outcomes assessed included delayed graft function, acute rejection, CMV infection, patient and graft survival, renal function, proteinuria, and uninephrectomy rates.

Main Results:

• Incidence of delayed graft function and acute rejection was similar between the CsA and SRL groups.
• Three-year patient survival was higher in the CsA group (89%) compared to the SRL group (76%).
• Proteinuria was higher, and uninephrectomy rates were numerically higher in the SRL group, associated with renal failure.

Conclusions:

• A CNI-free immunosuppressive protocol using rATG, SRL, MMF, and prednisone does not offer advantages over a standard CsA, MMF, and prednisone regimen in DKT for older patients with marginal organs.
• The standard CNI-based protocol demonstrated comparable or superior outcomes in terms of patient survival and graft complications.