Early Experience Using Calcineurin-Free Protocol In Recipients of High-Risk Cadaver Renal Transplants

The use of calcineurin inhibitors (CNI) is associated with significant nephrotoxicity, especially DGF in recipients of marginal allografts. Acute nephrotoxicity, which occurs in the early period after transplantation, leads to a higher rate of dialysis, and chronic nephrotoxicity may eventually result in graft loss. Avoidance of CNI for a prolonged period de novo after cadaver donor (CD) renal transplantation may facilitate recovery from DGF. Sirolimus (SRL) and mycophenolate mofetil (MMF) can be administered in the setting of DGF without exacerbating the impaired renal function after transplantation. To study the efficacy and tolerability of using a CNI-free induction protocol, a SRL-MMF combination plus interleukin-2R: (IL2R) antibody (basiliximab-Simulect) induction was administered to 24 consecutive adult recipients of marginal CD transplants (ie, donor age over 60 years, history of longstanding hypertension or diabetes mellitus, or cold ischemia time over 36 hours).