Calcineurin Inhibitors (CNIs) and Corticosteroids have been the main immunosuppressive agents in solid organ transplantation. Many studies have confirmed the positive impacts of withdrawal/avoidance of these agents, separately, on their side effect profiles. A pilot study was performed avoiding both agents among low-immunological-risk living donor kidney transplant recipients at a single center. Seventeen recipients were maintained on the double avoidance protocol during the study period beginning July 2002 through December 2003. Three rejection episodes occurred (out of ten) among related donor kidney recipients and six episodes (out of seven) among unrelated donor kidney recipients. Although most of the rejections were reversed with a short course of corticosteroids, the protocol was revised to exclude the unrelated donor kidney recipients. There were higher incidences of wound complications among recipients who received the initial loading dose of Sirolimus. Double avoidance of CNIs and corticosteroids is possible in living donor kidney transplant recipients with an acceptable incidence of rejection. Proper management of the side effects of Sirolimus could further minimize the incidence of rejection. A multi-center randomized study is recommended in order to recognize the benefits of avoiding CNIs and corticosteroids in renal transplant recipients.
Adrenal Cortex Hormones ; Adult ; Aged ; Antibodies, Monoclonal/*therapeutic use ; Calcineurin/antagonists & inhibitors ; Chimeric Proteins/*therapeutic use ; Drug Therapy, Combination ; Enzyme Inhibitors ; Female ; Glucocorticoids/*therapeutic use ; Humans ; Immunosuppressive Agents/*therapeutic use ; *Kidney Transplantation ; *Living Donors ; Male ; Methylprednisolone/*therapeutic use ; Middle Aged ; Mycophenolic Acid/*analogs & derivatives/*therapeutic use ; Pilot Projects ; Sirolimus/*therapeutic use