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  • Title: Preapheresis immunosuppressive induction: necessary or harmful?
    Author: Wennberg L, Genberg H, Tydén G.
    Journal: Transplantation; 2007 Dec 27; 84(12 Suppl):S37-9. PubMed ID: 18162987.
    Abstract:
    In ABO-incompatible kidney transplantation, only a few studies have addressed the necessity, duration, and content of immunosuppressive induction therapy. At our center (Karolinska Institute, Stockholm, Sweden), using a preconditioning regimen consisting of 13 days of tacrolimus, mycophenolate mofetil, and prednisolone, we have investigated both short- and long-term renal allograft function (up to 28 days and 1 year after transplantation, respectively) and correlated them to tacrolimus 12-hr trough levels. In summary, during the first 28 days after transplantation, renal allograft function in the ABO-incompatible group was impaired when compared with that observed in the ABO-compatible group. One possible explanation for this finding is the prolonged pretransplantation exposure to tacrolimus in the ABO-incompatible group, resulting in tacrolimus-associated renal toxicity, which slows the reduction in plasma creatinine. In fact, the day before, and also immediately after, the transplantation (for the first 3-4 postoperative days), the tacrolimus 12-hr trough levels in the ABO-incompatible group were greater than in the ABO-compatible group. Possibly, a shorter pretreatment period with tacrolimus or a reduced target tacrolimus trough level could eliminate this difference in postoperative renal allograft function. However, 1 year after transplantation, kidney allograft function in the two study groups was similar.
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