SUCCESSFUL KIDNEY TRANSPLANTATION IN HIGHLY SENSITIZED PATIENTS WITH ONCE DAILY TACROLIMUS BASED IMMUNOSUPPRESSION

Background: The once-daily (QD) formulation of tacrolimus (Tac) showedsimilar efficacy than twice-daily (BD) Tac and seems to improve adherence inkidney transplant (KT) recipients. The aim of our study was to define theefficacy and the safety of "de novo" QD Tac administration in KT recipients whoshowed pre KT high panel reactive antibodies (PRA).Methods: Twentyeight patients with a median PRA of 88.3%(range 64-100)who underwent KT were enrolled in the study. Patients were transplanted with anegative crossmatch performed using both cytotoxic and flow-cytom etricmethods. All patients received following immunosuppress ion: basiliximab,steroids, QD-Tac based at 0.2 mg/kg to reach a trough levels of 7-10 ng/mL;27 patients received mycophenolate and one everolimus also. All patients wereanalyzed for donor specific HLA-antibodies (HLA-DSA) by solid phase LuminexSingle Antigen bead assay, at 1 and 6 months from KT and then yearly.Results: Median follow-up was 26.4 months (range 2-57). The 3 yearspatients and graft survival were 100%. The median creatinine at last follow-upwas 1.5 mg/dl (range 0.9-3.1); no patients showed proteinuria. One patientexperienced acute rejection (category 4 IIA Banff '07) at POD 9; after steroidsbolus he was switched to BD Tac because the difficulties to achieve atherapeutic Tac level. No patient developed HLA-DSA throughout the follow up.Conclusion: QD formulation of Tac showed excellent graft and patientsurvival also in highly sensitized patients. A careful care is mandatory in earlyKT to achieve a therapeutic trough Tac levels.