SET Best Abstracts Session (Videos Available)

Monday July 02, 2018 from 09:45 to 11:15

Room: N-111

322.7 Usefulness of delayed introduction of tacrolimus in kidney transplants (KT) with Type III-DCD

Lara Ruiz Martínez, Spain

Nephrology service
Marqués de Valdecilla University Hospital

Abstract

Usefulness of Delayed Introduction of Tacrolimus in Kidney Transplants (KT) with Type III-DCD

Lara Ruiz-Martínez1, Marina De-Cos-Goméz1, Rosalia Valero-San-Cecilio1, Emilio Rodrigo-Calabia1, Milagros Heras-Vicario1, Mara Serrano-Soto1, Lara Belmar-Vega1, Michal Cervienka1, Eduardo Miñambres-Garcia2, Juan Carlos Ruiz-San-Millán1.

1Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; 2Intensive Care Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain

Introduction: Nephrotoxicity due to renal vasoconstriction induced by tacrolimus implies an increased risk of acute tubular necrosis and delayed  graft function. In KT using type II-DCD, due to its special vulnerability, the delayed introduction of calcineurin inhibitors is usually accepted as a basic (ideal) strategy. Our study  compares two immunosuppressive strategies: delayed introduction of tacrolimus plus thymoglobulin vs initial tacrolimus plus Basiliximab.on the results KT with type III-DCD.
Material and methods: We analyzed all the transplants performed using type III-DCD in our hospital between 2014-2017 (42). They were distributed in a first stage with delayed tacrolimus (3-4º day) + thymoglobulinand a second one with initial tacrolimus + basiliximab, with a follow-up of 6 months. The rate of delayed graft function, the evolution of renal function and the incidence of rejection were compared.
Results: 28 patients received thymoglobulin with delayed tacrolimus (start at 3.42 ± 1.9 days) and 13 patients received basiliximab and FK from day 0 (1 excluded without induction), in both groups at low doses (0.05mg / kg / 12h). Both groups are comparable in terms of demographic characteristics (age, sex and cardiovascular risk factors) and cold ischemia time. There were no significant differences in DGF, 27% group I and 23% group II (pNS). Serum creatinine at day 3, 7, 14, 30 and 180 (excluding the first days those who required dialysis) was 4.05 ± 2.5 mg / dl, 2.27 ± 1.7 mg / dl, 2.09 ± 1.3 mg/dl, 1.49 ± 0.7 mg/dl and 1.45 ± 0.49 mg/dl for group I and 3.15 ± 1.5 mg/dl, 2.08 ± 1.3 mg/dl, 2.07 ± 1.3 mg/dl, 1.73 ± 1.2 mg/dl, 1.6 ± 0.8 mg/dl for group II (no statistically significant differences). The levels of tacrolimus measured at 10, 30, 90 and 180 days after transplantation were 10.81 ± 3.3, 10.10 ± 2.3, 9.6 ± 3.5 and 7.8 ± 2.06 ng/ml for group I and 10.36 ± 2, 12 ± 1.7, 9.4 ± 2.2 and 8.1 ± 2.28 ng/ml for group II, showing similar levels, except for the first month when they present statistically significant differences (p = 0.007). Three patients in group 1 (10.7%) and 2 in group 2 (15.4%) experienced rejection, without statistically significant differences (pNS).
Conclusions: The delayed introduction of tacrolimus does not seem to suppose a benefit in KT using typeIII-DCD, therefore, the use of thymoglobulin, with its higher profile of adverse effects, seems not justified in patients with normal immunological risk.

This study was carried out in collaboration with the group of IDIVAL-Hospital Universitario Marqués de Valdecilla and REDINREN RD16/0009/0027. Instituto de Salud Carlos III. Ministerio de economía y competitividad.



© 2024 TTS2018