The impact of different induction immunosuppression protocol on patient survival, graft survival and acute graft rejection after kidney transplantation – multicenter study
Matej Vnučák1, Karol Graňák1, Monika Beliančinová1, Igor Gaľa2, Andrea Kováčová3, Michaela Chrapeková3, Ľuboslav Beňa2, Zuzana Žilinská3,4, Ivana Dedinská1.
1Transplantation Center, University Hospital in Martin and Jessenius Medical Faculty of the Comenius University, Martin, Slovakia (Slovak Republic); 2Transplant Department, Louis Pasteur's University Hospital, Košice, Slovakia (Slovak Republic); 3Department of Urology with Kidney Transplant Center, University Hospital in Bratislava, Faculty of Medicine, Comenius University, Bratislava, Slovakia (Slovak Republic); 45th Department of Internal Medicine, University Hospital in Bratislava, Faculty of Medicine, Comenius University, Bratislava, Slovakia (Slovak Republic)
Background: The path of success of kidney transplantation reflects the accuracy of immunological risk assessment and the choice of the correct induction and maintenance immunosuppression to avoid acute kidney rejection.
Methods: We performed multicentre prospective analysis consisting of patients after kidney transplantation with 12-month follow-up. The aim of the study was to stratify the immunological risk based on the presence of risk factors using different induction immunosuppressive protocols.
Results: 152 kidney transplant recipients were included, 100 males (66.4 %). We divided patients according to induction immunosuppression: no induction (n = 19), induction with basiliximab (n = 60), induction with ATG cumulative does 3.5 mg/kg (n = 42) and 6 mg/kg (n = 31). In our study, we demonstrated a shorter survival of patients without induction immunosuppression. In basiliximab group duration of dialysis ≥ 3 years (P = 0.0191), cold ischaemia time ≥ 1020 minutes or expected delayed graft function (P < 0.0001) are independent risk factors for graft loss (P = 0.0097).
Conclusions: Risk of no induction immunosuppression significantly exceeds the risks associated with its administration and is desirable even in patients with low immunological risk. Induction immunosuppression should be tailored individually from patient to patient.
Matej Vnučák: participated in performing the research and writing the paper Karol Graňák: participated in writing the paper Monika Beliančinová: participated in data collection Igor Gaľa: participated in data collection Michaela Chrapeková: participated in data collection Andrea Kováčová: participated in data collection Ľuboslav Beňa: participated performing research Zuzana Žilinská: participated performing research Ivana Dedinská, PhD.: participated in writing the paper, statistical analysis.
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