Is a calcineurin inhibitor required as part of the immunosuppression scheme in kidney transplant recipients that share 2-haplotypes with their donors?

Introduction. The recipients of HLA-identical live-donors grafts (RKT 2HP) have a low immunologic risk, and it is common to use immunosuppressive regimen with two medicaments excluding the calcineurin inhibitor. This study compares the long term outcomes of the double immunosuppressive therapy versus the triple therapy in RKT 2HP. Materials and methods. This study is a retrolective cohort. The patients were divided in two groups: 1) RKT 2HP who receive double immunosupresive therapy and 2) RKT 2HP with triple immunosupresive therapy. The outcomes evaluated were: renal function, acute rejection rate, lost of renal allograft, death rate, infections and hospitalization, change in the immunosupresive therapy and its causes. Results. We analyzed 85 kidney transplant recipients who share two haplotypes, 60 in the group 1 and 25 in the group 2. The median of time of follow-up in the group I was 138 months (min 23 and max 302) and 55 months (min 12 and max 106) in the group 2. There were four cellular acute rejection and nine allograft lost in patients of the group I. There wasn't any significant difference between the allograft outcome and the renal function at 60 months of follow out between the groups. 23 patients had change in the immunosuppressive therapy, 12 (53%) in the group 1 and 11(47%) in the group 2. The major cause of change of therapy in the group I was leucopenia by azatioprin (five patients); and in the group 2 was nephrotoxicity for calcineurin inhibitor (six patients). Discussion. Despite the evident nephrotoxicity, the use of calcineurin inhibitor is useful even in patients with low immunologic risk. According to the time of follow-up between the groups, even when the allograft survival was superior in group 2, the difference wasn't significative, it might be because the lower number of patients in group 1.