Immunosuppression and Prophylaxis
Basiliximab (20 mg at days 0 and 4 of operation) or anti-thymocyte
globulin (ATG; for high-risk patients, 3 mg/kg during operation and 1,5
mg/kg at postoperative days 1 and 2) were used as induction therapy.
Methylprednisolone 1000 mg was given intra-operatively.
Methylprednisolone dose was decreased by half every day and 20 mg oral
prednisolone was started on the 6th postoperative day for daily use.
Oral prednisolone dosage was reduced gradually to reach 5 mg a day in
the first year after transplantation. Calcineurin inhibitors (tacrolimus
or cyclosporin) and mycophenolate mofetil (MMF; 2 g /day in two divided
doses) or mycophenolate sodium (MMF; 1440 mg/day, in two divided doses)
were used as maintenance immunosuppression therapy. MMF was used as 600
mg/m2 in two divided doses in children. We considered both mycophenolate
mofetil and mycophenolate sodium in doses described above as the same
drugs in our study. Everolimus was used in only one case (plasma level
of the drug was targeted as 8-10 mg/dl). Trimethoprim/sulfamethoxazole
and valganciclovir (450 mg a day) was prescribed for Pneumocystis
jirovecii and cytomegalovirus (CMV) prophylaxis for 6 months after the
transplantation. Acute rejection was diagnosed by kidney biopsy. The
acute cellular rejection was treated with intravenous pulse
methylprednisolone or ATG depending on the severity of the rejection.
Plasmapheresis was added for acute humoral rejection. Delayed graft
function (DGF) was described as a need for hemodialysis in the first
week of kidney transplantation.