Tong-term clinical results of the use of photopheresis as a prophylaxis of renal allograft rejection


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Abstract

OBJECTIVE. TO DETERMINE THE FUNCTION OF THE RENAL ALLOGRAFT IN THE LONG-TERM PERIOD AFTER TRANSPLANTATION IN COMBINATION WITH PHOTOPHERESIS. MATERIAL AND METHODS. AN OPEN-LABLE, RANDOMIZED COHORT TRIAL WAS CONDUCTED. 60 RECIPIENTS OF THE RENAL ALLOGRAFT OBTAINED FROM 30 POSTMORTEM DONORS WERE EXAMINED. PATIENTS WERE RANDOMIZED INTO 2 GROUPS. ALL GRAFTS WERE PAIRED; PATIENT OF THE MAIN GROUP RECEIVED ONE KIDNEY, AND PATIENT OF THE COMPARISON GROUP - OTHER ONE. THIRTY PATIENTS IN THE MAIN GROUP RECEIVED STANDARD IMMUNOSUPPRESSION (TACROLIMUS, MYCOPHENOLATES, PREDNISOLONE) AND 10-15 PHOTOPHERESIS SESSIONS DURING THE FIRST 6 MONTHS AFTER TRANSPLANTATION. THIRTY PATIENTS IN THE COMPARISON GROUP RECEIVED ONLY STANDARD IMMUNOSUPPRESSION. THERE WERE NO DIFFERENCES IN THE MAIN CLINICAL INDICATORS BETWEEN PATIENTS AT THE TIME OF INCLUSION IN THE STUDY. THE OBSERVATION PERIOD WAS 2 TO 7 YEARS, AN AVERAGE OF 4.5±2,0 YEARS. End POINTS: PRIMARY - GRAFT LOSS (INCLUDING THE DEATH OF THE RECIPIENT WITH THE FUNCTIONING GRAFT), SURROGATE - NUMBER OF REJECTION CRISES, DYNAMICS OF BLOOD CREATININE CONCENTRATIONS, GLOMERULAR FILTRATION RATE, AND DAILY PROTEINURIA. RESULTS. THE FUNCTION OF RENAL ALLOGRAFT WAS BETTER IN THE MAIN GROUP: LOWER AVERAGE SERUM CREATININE LEVEL (P=0.017), LOWER DAILY PROTEINURIA (P=0.027), AND HIGHER GLOMERULAR FILTRATION RATE (P = 0.013). REJECTION WAS DETECTED IN TWO PATIENTS OF THE MAIN GROUP (3 EPISODES) AND IN SEVEN PATIENTS OF THE COMPARISON GROUP (8 EPISODES). THE RELATIVE RISK OF REJECTION IN THE MAIN GROUP WAS SIGNIFICANTLY LOWER THAN IN THE COMPARISON GROUP: 0.2509 (95% Cl, 0.05386-0.9167, P=0.0358). THE RISK OF GRAFT LOSS WAS ALSO LOWER IN THE MAIN GROUP: 0.2782 (95% Cl, 0.07562-0.8657, P = 0.026). GRAFT SURVIVAL RATE WAS HIGHER IN THE MAIN GROUP (LOG RANK P=0.009; BRESLOW P =0.005). CONCLUSION. PHOTOPHERESIS IS AN EFFECTIVE METHOD FOR THE PREVENTION OF GRAFT REJECTION: IT IMPROVES THE FUNCTION IN THE LONG-TERM POSTTRANSPLANT PERIOD, AND REDUCES THE RISK OF REJECTION.

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About the authors

A. P Fayenko

SBHCI "Moscow Regional Scientific Research Clinical Institute n.a. M.F. Vladimirsky"

Email: alexfaenko@mail.ru
Teaching Assistant in the Course of Clinical Transjusiology at the Department of Anesthesiology and Emergency Medicicne of the Faculty of Continuing Medical Education

A. B Zulkarnaev

SBHCI "Moscow Regional Scientific Research Clinical Institute n.a. M.F. Vladimirsky"

octor of Medical Sciences, Chief Researcher at the Surgical Department of Transplantology and Dialysis

V. A Fedulkina

SBHCI "Moscow Regional Scientific Research Clinical Institute n.a. M.F. Vladimirsky"

PhD in Medical Science, Senior Researcher at the Surgical Department of Transplantology and Dialysis

R. O Kantaria

SBHCI "Moscow Regional Scientific Research Clinical Institute n.a. M.F. Vladimirsky"

PhD in Medical Science, Nephrologist at the Surgical Department of Transplantology and Dialysis

A. V Kildyushevsky

SBHCI "Moscow Regional Scientific Research Clinical Institute n.a. M.F. Vladimirsky"

Doctor of Medical Sciences, Professor, Leading Researcher at the Department of Surgical Hemocorrection and Detoxification

A. V Vatazin

SBHCI "Moscow Regional Scientific Research Clinical Institute n.a. M.F. Vladimirsky"

Doctor of Medical Sciences, Professor, Head of the Department of Transplantology, Nephrology and Surgical Hemocorrection, Honored Scientist of the Russian Federation

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