Introduction:To analyze the relationship among cold ischaemia time (IT), incidence of delayed graft function (DGF), levels of inmunosupresor drugs and incidence of biopsy-proven acute rejection (BPAR) with renal function (serum creatinine (SCr) and glomerular filtration rate calculated with CKD-EPI formula (GFR)) in the early post-transplant period in patients transplantated with an induction protocol that includes everolimus combinated with tacrolimus.
Materials and methods:12 patients have been transplantated with an induction protocol based in basiliximab, corticosteroids, everolimus and tacrolimus, 6 men and 6 women.Mean age of donors was 48.25 ± 14,6 years and recipients one was 43.5 ± 10,6 years.Average IT was 15,17 ± 5,1 hours and incidence of DGF was 25%.Levels of tacrolimus and everolimus were measured at the first week and the first month, as well as the incidence of BPAR, SCr, GFR and their relationship with IT and DGF.
Results and Discussion: Incidence of BPAR was of 25%, all of them cellular rejections and occurred in the first month post-transplant.Average levels of EVL at first week and the first month were 4.13 ± 0,75 ng/ml and 5.23 ± 1.54 ng/ml, and the levels of FK506 were 7.6 ± 2,4 ng/ml and 9,09 ± 3.32 ng/ml.No differences were observed between levels of EVL and FK506 (nor the addition of both drugs) at the first week and the first month among patients with or without BPAR (p=0,29).First month SCr of the whole series was 1,59 ± 0.43 mg/dl; in patients with BPAR was 1.88 mg/dl ± 0,27 and in patients without BPAR was of 1.49 mg/dl ± 0.45 (p=0,19).In patients with DGF, first- month SCr was 1.94 ± 0.32 mg/dl and in patients without DGF was 1,47 ± 0.42 mg/dl (p=0,07).Patients with DGF had a longer IT (20,96 ± 0.95 hrs vs 13,23 ± 4,3 hrs,p=0.013) and a higher proportion of patients with DGF suffered early BPAR (66,7% vs 33,3%. p=0.054).SCr was significantly higher in those patients with a longer IT (p=0.009) and non-significant in patients with DGF and/or BPAR (p=0.07 y p=0.19 ,respectively).GFR was significantly lower in those patients with a longer IT (p=0.042), but without significance in patients with DGF (56,5 ml/min ± 8,83 vs 38,3 ml/min ± 3,5 , p= 0,189) or with BPAR (57,88 ml/min ± 25,3 vs 35,3 ml/min ± 8,38, p=0,306).
Conclusions:First-month renal function in transplantated patients with an induction protocol with everolimus and tacrolimus was excellent despite a high incidence of BPAR. Incidence of DGF and a longer IT was associated with a higher incidence of BPAR, though in a non-significant way.Levels of immunosupressor drugs at the first week and in the first month were not different in patients with or without BPAR or DGF.A longer IT was associated with a higher incidence of DGF and a worse renal function at the first month.First-month renal function shows a trend to be worse in patients with DGF and/or BPAR. A longer number of cases and follow-up time are necessary to confirm these results.