Outcomes of EC-MPS combined with low-dose tacrolimus in DCD kidney transplantation for high-risk DGF recipients

Effective use of immunosuppressive agents to avoid the occurrence of nephrotoxicity and rejection in recipients with delayed graft function (DGF) is a concern for physicians. We investigated the outcomes of treatment with enteric-coated mycophenolate sodium (EC-MPS) in combination with a low-dose of tacrolimus (Tac) in renal transplantation for recipients with a high risk of DGF. We conducted a retrospective study of 61 recipients with a high risk of DGF who were treated with EC-MPS and low-dose Tac. The recipients were separated into a no-DGF group and a DGF group, based on whether DGF actually occurred. The results showed that although EC-MPS and Tac doses were similar in both groups, the percentage of recipients whose mycophenolic acid area under the curve 0–12 h (MPA-AUC0–12 h) was below 30 (mg·h)/L was significantly higher and the Tac trough concentration significantly lower in the DGF group one week after transplantation. Notably, a higher incidence of biopsy-proven acute rejection (BPAR) was found in the DGF group and among all recipients whose MPA-AUC0–12 h was less than 30 (mg·h)/L at one week after transplantation. One-year graft survival, patient survival, allograft function, and the incidence of the most common adverse events were similar in the two groups. In conclusion, the immunosuppressive regime is applicable to Chinese kidney transplant recipients, and early low exposure to EC-MPS was related to acute rejection in the recipients at a high risk of DGF.摘要目的分析心脏死亡供体(DCD)肾移植中移植物功能延迟恢复(DGF)高风险受者应用米芙(EC-MPS) 联合低剂量他克莫司治疗术后1年的有效性及安全性,指导临床用药。创新点对比DGF 高风险受者术后发生DGF 及正常恢复受者的免疫抑制剂药代动力学特征。方法将本中心进行肾移植的61 例DGF 高风险受者按照实际病情纳入DGF 组及正常恢复组,均行米芙联合低剂量他克莫司免疫抑制治疗。对比两组免疫抑制剂血药浓度及预后各项指标。结论DGF 组及正常恢复组间米芙及他克莫司剂量无显著差异。术后1 周DGF 组EC-MPS 血药浓度曲线下面积小于30 (mg·h)/L 的比率显著高于正常恢复组,同时他克莫司谷浓度显著低于正常恢复 组,DGF 组经活检证实的急排反应的发生率显著 高于正常恢复组,术后1 周的EC-MPS 血药浓度曲线下面积低于30 (mg·h)/L 的受者中经活检证实的急排反应的发生率显著高于其他受者。1 年移植物存活率、移植物功能及常见不良反应在两 组间未见明显差异。