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. 2020 Nov 23;21(1):501.
doi: 10.1186/s12882-020-02137-5.

Tailored immunosuppression after kidney transplantation - a single center real-life experience

Miriam Good-Weber  1 , Malgorzata Roos  2 , Thomas F Mueller  1 , Barbara Rüsi  3 , Thomas Fehr  4   5
Affiliations

Tailored immunosuppression after kidney transplantation - a single center real-life experience

Miriam Good-Weber et al. BMC Nephrol. .

Abstract

Background: Kidney allograft survival continuously improved with introduction of novel immunosuppressants. However, also immunologically challenging transplants (blood group incompatibility and sensitized recipients) increase. Between 2006 and 2008, a new tailored immunosuppression scheme for kidney transplantation was implemented at the University Hospital in Zurich, together with an ABO-incompatible transplant program and systematic pre- and posttransplant anti-human leukocyte antigen (HLA) antibody screening by Luminex technology. This study retrospectively evaluated the results of this tailored immunosuppression approach with a particular focus on immunologically higher risk transplants.

Methods: A total of 204 consecutive kidney transplantations were analyzed, of whom 14 were ABO-incompatible and 35 recipients were donor-specific anti-HLA antibodies (DSA) positive, but complement-dependent cytotoxicity crossmatch (CDC-XM) negative. We analyzed patient and graft survival, acute rejection rates and infectious complications in ABO-compatible versus -incompatible and in DSA positive versus negative patients and compared those with a historical control group.

Results: Overall patient, death-censored allograft survival and non-death-censored allograft survival at 4 years were 92, 91 and 87%, respectively. We found that (1) there were no differences between ABO-compatible and -incompatible and between DSA positive and DSA negative patients concerning acute rejection rate and graft survival; (2) compared with the historical control group there was a significant decrease of acute rejection rates in sensitized patients who received an induction with thymoglobulin; (3) there was no increased rate of infection among the patients who received induction with thymoglobulin compared to no induction therapy.

Conclusions: We observed excellent overall mid-term patient and graft survival rates with our tailored immunosuppression approach. Induction with thymoglobulin was efficient and safe in keeping rejection rates low in DSA positive patients with a negative CDC-XM.

Keywords: ABO-incompatibility; Donor-specific antibodies; Induction therapy; Kidney transplantation; Rejection; Thymoglobulin.

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Conflict of interest statement

The authors have no conflict of interest to declare with respect of this work.

Figures

Fig. 1
Fig. 1
Outcome of kidney transplantation overall (n = 204 patients). Kaplan-Meier survival curves are shown for (a) patient survival and (b) death-censored graft survival
Fig. 2
Fig. 2
Outcome of kidney transplantation in ABO compatible (n = 189) versus ABO incompatible (n = 14) patients. Kaplan-Meier survival curves are shown for (a) patient survival and (b) death-censored graft survival
Fig. 3
Fig. 3
Outcome of kidney transplantation in DSA negative (DSA-, n = 168) and DSA positive (DSA+, n = 35) patients. Kaplan-Meier survival curves are shown for (a) patients survival and (b) death-censored graft survival
Fig. 4
Fig. 4
Induction therapies and rejection-free survival. a Distribution of the different induction therapies in the whole study group (n = 204 patients). b Comparison of acute rejection-free survival between patients with and without any type of induction therapy. c Comparison of acute rejection-free survival between the two most important induction therapies thymoglobulin and basiliximab (p = 0.656). Acute rejection rates after 12 months were 22.9% for thymoglobulin, 28.4% for basiliximab and 40.6% for the no induction group
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