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Usefulness and safety of high-dose mizoribine on ABO-incompatible living related kidney transplantation using anti-CD20 and anti-CD25 antibodies without splenectomy: 3-year results.
- Source :
-
Transplantation proceedings [Transplant Proc] 2014; Vol. 46 (2), pp. 391-4. - Publication Year :
- 2014
-
Abstract
- Background: Mizoribine (MZR) has been developed as an immunosuppressive agent in Japan, but has a less potent immunosuppressive effect up to 3 mg/kg/d. We previously reported that high-dose MZR, at 6 mg/kg/d, would be effective and safe for ABO-incompatible(ABO-i) living donor kidney transplantation (LDKT) patients when combined with cyclosporine (CsA) or tacrolimus(FK), anti-CD20 and anti-CD25 monoclonal antibodies, and corticosteroid without splenectomy in a 1-year study. Therefore, we observed these patients for 3 years.<br />Methods: From 2007 to 2010, we encountered 24 cases of ABO-i LDKT using anti-CD20 and anti-CD25 monoclonal antibodies without splenectomy. The pretransplantation immunosuppressive regimen consisted of two doses of anti-CD20 antibody, mycophenolate mofetil (MMF, 25 mg/kg/d), prednisolone, calcineurin inhibitor (CNI; CsA 7 mg/kg or (FK 0.2 mg/kg) and two doses of anti-CD25 antibody. Antibody removal by plasmapheresis was performed before LDKT up to several times according to the antibody titer. The post-transplantation regimen consisted of high-dose MZR (6 mg/kg/d) instead of MMF (MZR group, N = 12) .<br />Results: The 3-year graft survival rates for the MZR and MMF groups were 91.7% and 100%, respectively. Serum creatinine levels for the MZR and MMF groups were 1.44 mg/dL and 1.31 mg/dL at 1 year, 1.55 mg/dL and 1.41 mg/dL at 2 years, and 1.51 mg/dL and 1.48 mg/dL at 3 years, respectively (not significant [NS]). The MZR group did not show a higher rate of elevated serum uric acid values. The percentage of patients who were administered anti-uric medication was 42.5% (5/12) in the MZR group and 50% (6/12) in the MMF group (P = NS) at the third year. Severe infection, such as cytomegalovirus, herpes zoster, was not observed at the second and third years in both groups.<br />Conclusion: A high-dose MZR regimen including CNI (CsA or FK), steroid, and anti-CD20 and anti-CD25 antibodies without splenectomy was effective and safe in ABO-i renal transplantation.<br /> (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Subjects :
- Creatinine blood
Dose-Response Relationship, Drug
Humans
Immunosuppressive Agents administration & dosage
Immunosuppressive Agents adverse effects
Ribonucleosides administration & dosage
Ribonucleosides adverse effects
Splenectomy
ABO Blood-Group System
Antibodies, Monoclonal therapeutic use
Antigens, CD20 immunology
Immunosuppressive Agents therapeutic use
Interleukin-2 Receptor alpha Subunit immunology
Kidney Transplantation
Ribonucleosides therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2623
- Volume :
- 46
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Transplantation proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 24655971
- Full Text :
- https://doi.org/10.1016/j.transproceed.2013.10.061