Initiale immunosuppression ohne calcineurin-antagonisten nach nierentransplantation im rahmen des old-for-old-programmes

Introduction: In order to avoid nephrotoxicity our > 65 year-old receipients of >65 year-old donor kidneys were administered initial immunosuppression without calcineurin inhibitors in favour of a combination of an IL-2 receptor antagonist together with MMF and cortisone. After stabilisation of graft function, calcineurin inhibitors were added to the protocol. Patients and methods: From June 1999 to November 2003 a total of 38 patients with a mean age of 67,9 (65 - 80 yrs) receiving local organs of donors with a mean age of 69,3 (65 - 83 yrs) were administered immunosuppressive therapy without initial use of calcineurin inhibitors within a regimen consisting of Simulect (n = 30) or Zenapax (n = 8) together with MMF and cortisone. Cyclosporin A (n = 28, target CO-level 180 - 200 ng/ml) was started on day 8,2 (4 - 42) and Tacrolimus (n = 10, target level 8 - 10 ng/ml) on day 4,1 (1 - 6), respectively. With a rather bad HLA mismatch of MM-AB 2,6 (0 - 4) and MM-DR 1,3 (0 - 2), respectively, the mean cold ischemia time was relatively low at 14:01 (05:04 - 22:50). Results: The initial rate of non-function of 31,6% (12/38) was reversible. The total of 10 rejection episodes (26,3%) treated with steroid bolus therapy also were reversible. All infections except 1 Listeria meningitis with ensuing neurological complications were treated successfully. 1 graft loss at month 6 was due to chronic rejection. One patient each died from cardiac cause at month 11, from neurological problems at month 17 and from oncological cause at month 27. The 1-year patient and graft survival was 97,4 and 94,7%, respectively, the 2-year patient and graft survival was 92,1% each. Mean serum creatinine value was 1,5, 1,5 and 1,7 mg% at months 6, 12 and 24, respectively. Conclusions: In patients older than 65 years receiving kidneys from donors older than 65 years, very good results can be achieved using an initial calcineurin inhibitor free immunosuppression by administration of a IL-2 receptor antagonist together with MMR and cortisone.