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2013 ; 86
(4
): 367-70
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Clinical experience with induction therapy in renal transplantation
#MMPMID26527980
Muntean A
; Lucan M
; Barbos A
; Elec A
; Iacob G
; Loga L
; Dican L
Clujul Med
2013[]; 86
(4
): 367-70
PMID26527980
show ga
INTRODUCTION: Acute rejection (AR) is a major determinant of renal allograft
survival. The incorporation of new immunosuppressive agents explains the
improvement seen in the results of transplantation in recent years. OBJECTIVE: To
assess the optimal immunosuppression regimen according to the immunological risk
of renal transplant patients. METHOD: We performed a retrospective study of 977
consecutive patients transplanted in our institution between January 2000 and
December 2011. Recipients were classified according to the immunological risk
(high, intermediate and low) and the type of induction therapy received. We
evaluated the incidence of early acute rejection (eAR) and late acute rejection
(lAR) and their influence on graft and patients survival in relation to the
immunological risk and induction regimen used. RESULTS: The incidence of eAR was
5.4%, 6.4% and 1.4% in relation with the immunological risk, high, intermediate
and low respectively. The most commonly used induction immunosuppression was
rabbit antithymocyte globulin (ATG), followed by methylprednisolone and
basiliximab. No statistical difference was found between the incidence of eAR
according to the type of induction therapy and immunological risk. The graft
survival was significantly better for the cases without eAR at 1 year (98.6%
versus 94.4%, p=0.019), and 3 years (94.9% versus 88.9%, p=0.056). The patients
survival was significantly better for those without eAR at 1 year after
transplant (95.7% vs. 88.9%, p=0.051), 3 years (93.1% vs. 83.3%, p=0.008) and 5
years (92.2% vs. 79.6%, p=0.001). The incidence of lAR was between 0 and 7.1%
according to the induction therapy, lacking any statistical significance
(p=0.450). CONCLUSION: Tailoring the induction immunosuppression according to the
immunological risk reduces the incidence of early acute rejection.