Tailor-made medicine of ABO incompatible renal transplant recipients dsensitivity test at the beginning of desensitization therapy and just before operationesigned by lymphocyteimmunosuppressant

Abstract

ABO incompatible renal transplant recipients were administered immunosuppressive agents from one month before operation as desensitization immunosuppressive therapy. Lymphocyte-immunosuppressant sensitivity test(LIST)can predict the pharmacological efficacy for renal transplant recipients at just before transplantation. However, in case of ABO incompatible renal transplantation, the evaluation point of LIST has been unclear either at the beginning of desensitization immunosuppressive therapy or just before renal transplantation. Therefore, we evaluated pharmacological efficacies of tacrolimus(Tac), cyclosporine(CyA), and mycophenolic acid(MPA)by LIST, as well as ATP amounts in peripheral blood mononuclear cells(PBMCs)of patient origin, at both the beginning of desensitization immunosuppressive therapy and just before renal transplant operation. The study includes patients treated by Tac without basiliximab(Bax) (n=8), patients treated by Tac with Bax(n=10), and patients treated by CyA with Bax(n=11) immunosuppressive therapy. In the recipients treated by Tac without Bax, the rate of acute rejection episodes of the Tac high sensitivity group was significantly higher than that of the low Tac sensitivity group at only just before operation(p=0.022). However, the rate of cytomegarovirus (CMV)infection did not significantly correlate with Tac sensitivity. The rate of acute rejection episode or CMV infection was not significantly different between the above two patient subgroups at the beginning of desensitization immunosuppressive therapy. From these observations, we concluded that LIST should be carried out for the evaluation of Tac pharmacological efficacy at just before operation to predict occurrence of acute rejection episodes in renal transplantation.