Anti-CD25 monoclonal antibody coverage allows for calcineurin inhibitor 'holiday' in solid organ transplant patients with acute renal dysfunction.

摘要

BACKGROUND: Solid organ transplant (Tx) patients on calcineurin inhibitors (CNI) can develop acute renal dysfunction (ARD), which could be improved by reducing or withholding ("holiday") CNI dose. METHODS: We used anti-CD25 monoclonal antibodies to prevent acute rejection in 11 adult Tx patients (7 heart, 2 liver, 2 heart-renal Tx), requiring a CNI "holiday" because of 15 events of ARD after the initial postTx hospitalization. An event of ARD was defined as an increase in serum creatinine (Scr)>25% vs. baseline. The CNI "holiday" was implemented until Scr had decreased to baseline. Basiliximab was used in 7 patients (11 events), and daclizumab was used in 4 patients (4 events). RESULTS: The CNI "holiday" was implemented over 21+/-51 days. Anti-CD25 mAb were well tolerated with no episodes of acute rejection. Scr (micromol/liter) increased from 145+/-48 to 301+/-92 (P<0.0001), and decreased to 143+/-55 with the CNI "holiday." CONCLUSIONS: Our results suggest that a CNI "holiday" may improve ARD after solid organ Tx without rejection under anti-CD25 mAb coverage.