1.6
#67-OR
CHOICE OF INDUCTION THERAPY FOR SIROLIMUS TREATED RENAL RECIPIENTS BASED UPON IMMUNE RISK FACTORS.
Ronald H. Kerman, Ph.D. , Richard J. Knight, M.D. , Hal Gibson B.S. , Chris Garcia B.S. , Eva McKissick B.S. , Stephanie Rasmussen B.S. , Chris Ballew B.S. , Noriel Acorda B.S. , Stephen M. Katz, M.D. , Charles T. Van Buren, M.D. and Barry D. Kahan, Ph.D., M.D. . Houston TX, University of Texas Medical School-Houston, 77030, Department of Surgery .
Patients present for transplantation (Tx) with immunologic risks including re-Tx, Af-Am ethnicity, HLA Abs or a (+) FCXM. The rejection frequencies and immunosuppression of four groups were compared. Group 1 had 73 low-risk (1 Af-Am; all primary, 1°) recipients (recips) of cadaveric (cad) donors. All recips had 0% Flow-PRA, (=) FCXMs and received Simulect (Sim), Sirolimus (SRL), Prednisone (Pred), Neoral (CsA). Group 2 had 40 high-risk recips (21 Af-Ams, 20 re-Txs), with Flow PRA of 50±30%, and (=) FCXMs treated with Sim/SRL/Pred/CsA. Group 3 were 33 high-risk (14 re-Txs, 13 Af-Ams) recips with a 44±29% Flow PRA, (=) FCXMs treated with Thymoglobulin (Thymo)/SRL/Pred/CsA. Group 4 were 9 high-risk thymo/SRL/Pred/CsA recips similar to Group 3 except for the Group 4 HLA Ab of 72±22% and all 9 recips had (+) FCXMs. Group 1 low-risk recips had a 19% (14/73) rejection frequency with a first rejection on day 68±39. The high-risk Group 2 recips had a 43% (17/40) rejection frequency (43% vs 19%, p <0.01) with a first rejection on day 50±38 (50 vs 68, p <0.05). The high-risk Group 3 recips had no rejections. All 9 high-risk Group 4 recips had steroid resistant, antibody mediated rejections (first rejection on day 10±6; 10 vs 50, p <0.01) requiring plasmapheresis and OKT-3 or Thymo rescue. Thymo induction of SLR-treated recips can obviate some high-risks and prevent rejections. Patients with high HLA-Abs and a (+) FCXMs are at risk for vascular rejections requiring rescue.