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Hückelheim, Henning (2006): Nephrotoxizitätsfreie Immunsuppression bei älteren Empfängern von postmortal entnommenen Nieren älterer Organspender - Ergebnisse einer prospektiven Pilotstudie -. Dissertation, LMU München: Medizinische Fakultät



Background. With the aim to improve the inferior outcomes in elderly recipients of kidneys from elderly cadaver donors, we applied and investigated a therapeutic regimen consisting of Calcineurin- inhibitor-free, mycophenolate mofetil (MMF) – based immunosuppressive induction/maintenance protocol. In this article, we report the long-term results of this clinical trial. Methods. 89 recipients (mean age:63,8 y) of kidneys from cadaver donors (mean age: 66,8y) were consecutively recruited for this 5-year, prospective, open, single centre, pilot trial. Induction therapy consisted of MMF and steroids in conjunction with a a short course (4-10 days) of rabbit ATG. Maintenance treatment was performed with MMF/steroids or MMF alone under strict therapeutic drug monitoring by aiming target MPA-trough levels between 2 – 6 mg/mL. Results. Cumulative 5-year patient and renal allograft survival was 87,69 % and 69,81 %, respectively. Acute rejection episodes occurred in 23,6 % (21 patients). Long-term function of the old renal allografts proved to be satisfactory as reflected by serum Creatinine-values of 1,53 mg/dl and Urea-values of 57,9 mg/dl at 5 years. Conclusion. Application of a nephrotoxicity- and atherogenicity-free, MMF-based immunosuppressive induction/maintenance protocol in elderly recipient of kidneys from elderly cadaver donors leads to improved long-term outcomes which are comparable with data from young recipients who have received allografts from young cadaver donors.