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Highly sensitized patients with delayed graft function: a management protocol.

D P Hickey1, C A Vivas, M L Jordan

  • 1Department of Surgery, University Hospital, Pittsburgh, Pennsylvania.

The Journal of Urology
|January 1, 1991
PubMed
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Maintaining high cyclosporine doses in highly sensitized kidney transplant recipients with delayed graft function can improve graft survival. This approach may prevent irreversible rejection and lead to successful long-term outcomes.

Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • Delayed graft function (DGF) in renal transplants is associated with poorer graft survival.
  • Management of DGF in highly sensitized patients on cyclosporine is challenging.
  • Standard practice often involves reducing cyclosporine to avoid nephrotoxicity, risking under-immunosuppression and rejection.

Observation:

  • Three highly sensitized renal transplant recipients with DGF were treated.
  • These patients were deliberately maintained on high-dose cyclosporine throughout the DGF period.
  • Graft function was achieved at 2, 4, and 5 months post-transplant.

Findings:

  • High-dose cyclosporine maintenance during DGF was associated with successful graft function.
  • Long-term serum creatinine levels remained within acceptable ranges (2.7, 2.0, and 1.0 mg/dL at various post-transplant intervals).

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  • This strategy appears effective in preventing irreversible rejection in this high-risk cohort.

    • Implications:

    • Maintaining high cyclosporine levels may be a beneficial strategy for highly sensitized renal transplant recipients experiencing DGF.
    • This approach could improve graft survival rates in patients with DGF.
    • A proposed management protocol for such patients warrants further investigation.