The Effect of Adding Low dose Daclizumab to Renal Transplantation Standard Protocol on Reduction the Risk of Kidney Rejection in Renal Allograft Recipients
DOI:
https://doi.org/10.22100/jkh.v6i4.118Keywords:
Daclizumab, Renal transplantation, Acute rejection.Abstract
Introduction: Transplantation of the kidney is the choice treatment of advanced chronic renal failure. One of the most important therapeutic problems in these patients is the prevention of acute graft rejection. The purpose of this study was to investigate the efficiency of low dose Daclizumab for prevention of acute kidney graft rejection in living donor recipients.
Methods: This clinical trial study was performed on 120 living donor kidney recipients who were admitted to kidney transplant ward of Kerman Afzalipour hospital. These patients were randomly assigned into two intervention and control groups. The intervention group received Cyclosporine, Mycophenolate mofetil and Prednisolone plus Daclizumab at a dose of 1mg/kg before transplantation and then two weeks later. Other 60 patients received all above drugs except Daclizumab. All patients were followed up for at least 6 months for acute rejection, rejection episode time and the rate of infectious complications.
Results: The rate of acute rejection was significantly lower in the intervention group compared with the control group (6.7% vs. 18.3%; P=0.048). The six-month graft survival rate in the intervention group was 95% and in the control group it was 85% (P=0.029). There was a significant difference in 6-month graft survival between the women of the intervention and control groups (97% vs. 74%; P=0.02) but no significant difference was observed between the men in the two groups (94% and 92%). The incidence of serious infection was similar in the two groups
Conclusion: The use of induction therapy with two doses of Daclizumab in living donor kidney recipients reduces the incidents of acute rejection with improving graft survival especially in women and does not result in more infectious complications
References
Mitch W, Chronic kidney disease in: Goldman L, Ausiello D, Cecil Textbook of Medicine, 23rd edition, Saunders Elsevier,2008.p.922.
Tolkoff-Rubin N., Treatment of irreversible renal failure in: Goldman L., Ausiello D., Cecil Textbook of Medicine, 23rd edition, Saunders Elsevier,2008.p.941.
Mcevoy GK., Snow EK., AHFS drug information, 27th edition, Bethesda, USA, 2007, American Society of Hospital- System Pharmacists Inc.p.3672-4.
Pascual J., Marcén R., Ortuño J., Anti interleukin 2 receptor antibodies: basiliximab and daclizumab, Nephrol Dial Transplant. 2001;16:1756-1760.
Nazemian F, Naghibi M., Comparison of the efficiency of the prescription of the interleukin 2 receptor antagonist in living donor kidney recipient in Imam Reza hospital from 2001-2006, Mashhad Medical Faculty Journal, 2006;93(49):247-52.[Persian].
Ekberg H, Grinyó J, Nashan B, Vanrenterghem Y, Vincenti F, Voulgari A, et al. Cydosporine sparing with mycophenolate mofetil, daclizumab and corticosteroids in renal allograft recipients: The CAESAR study, Am J Transplant.2007 Mar;7(3):560-70.
Carpenter C., Milford E., Sayegh M., Transplantation in the treatment of renal failure in: Fauci A., Braunwald E., et al, Harrison's principles of internal Medicine, 17th Edition, McGraw Hill, 2008, p. 1777.
Goriaĭnov VA, Morozova MM, Kaabak MM, The influence of Daclizumab (Zenapax) on the post operative period in allogenic kidney recipients, Vestn Ross Akad Med Nauk, 2006;(3):18-21.
Ji SM, Li LS, Cheng Z, Cheng DR, Sun QQ, Chen JS, et al. A single dose daclizumab induction protocol in renal allograft recipients: a chinese single center experience, Transplant proc. 2007 Jun;39(5): 1396-401.
Lin M, Ming A, Zhao M., Two dose basiliximab compared with two dose daclizumab in renal transplantation: a clinical study, Clin Transplant. 2006;20(3):325-9.
Tang IY, Meier-Kriesche HU, Kaplan B, Immunosuppressive strategies to improve outcomes of kidney transplantation, semin Nephrol, 2007 Jul; 27(4):377-92.
Poorrezagholi F, Einollahi B, Firoozan A, Nafar M, Yadegari H, Moghaddam SM, et al. Effect of daclizumab on prevention of acute rejection of renal transplantation, Transplant proc. 2003,35:2735-2736.
Ekberg H, Persson NH, Källen R, Gül-Baykurt N., Two doses of daclizubnab in conjunction wigh low dose cyclosporine, mycophenolate mofetil, daclizumab and corticosteroids resulted in a low incidence of acute rejection after renal transplantation: Scand J Imun, 2003 dec,58(6):670-7.
Poorfarziani V., Lesan Pezeshki M., Einollahi B., Comparison of efficiency of Zenapax with Anti Lymphocyte Globolin in prevention of graft rejection in kidney transplantation recipient who are high risk immunologically, Kosar Medical Journal; 12(1): 69-73. [Persain].
Ciancio G, Burke GW, Gaynor JJ, Roth D, Kupin W, Rosen A, et al. A randomized trial of thymoglobulin vs. alemtuzumab (with lower dose maintenance immunosuppression) vs. daclizumab in renal transplantation at 24 months of follow-up, Clin Transplant, 2008: 22: 200-210.
Zhu YS, Xu AP, He HX, Fan LP, Nie HB, Nv J, et al. Half –dose zenopax for acute rejection prevention after renal transplantation, Nan Frang Yi ke da Xuexue Bao. 2006 Dec. 26(12):1818-20.
Jain A, Valentini RP, Gruber SA, West MS, Mattoo TK, Imam AA., Two dose daclizumab induction in pediatic renal transplantation, Pediatr Transplant 2009 Jun,3(4):490-4.
Pham K, Kraft K, Thielke J, Oberholzer J, Sankary H, Testa G, et al. Limited-dose Daclizumab versus Basiliximab: a comparison of cost and efficiency in preventing acute rejection, Transplant Proc. 2005 Mar;37(2):899-902.
Vega O, Cárdenas G, Correa-Rotter R, Alberú J, Morales-Buenrostro LE, Basiliximab vs. limited-dose daclizumab (2 mg/kg) administered in single or two separated doses in kidney transplantation: Revista De Invest Clin. 2008 Mar-Apr;60(2):82-6.
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