Immunosuppression:
Immunosuppressive treatment of the patients consisted of cyclosporine
(n=33 patients, 10.8%) or tacrolimus (n=261, 85.6%); mycophenolate
mofetil/mycophenolic acid (n=272, 89.2%) and prednisone (n=266,
87.2%). Cyclosporine was administered at a starting dose of 6–8 mg/kg
per day (twice daily) for the first 24 hours after transplantation, with
a later dosage adjustment to maintain the following blood concentration
levels: 200–400 ng/ml in month 1, 200–300 ng/ml in months 2–3,
150–250 ng/ml in months 4–6, and 100–200 ng/ml in months 6–12.
Tacrolimus was administered for the first 1–2 days after
transplantation at a dose of 0.2 mg/kg per day, aiming to target whole
blood concentration at 10 to 15 ng/ml in month 1, 7 to 10 ng/ml
in months 2–3, 6 to 8 ng/ml in
months 4–6, and 5 to 7 ng/ml in months 6–12. Mycophenolate
mofetil/mycophenolic acid was given at an induction dose of 2000 mg/1440
mg per day and a maintenance dose of 1000–2000 mg/760–1440 mg per day,
later reduced according to the immunology risk status of the patient.
The initial dose of 500 mg of 6-methylprednisolone was administered
intra-operatively intravenously (IV), then 250–500 mg IV 1 or 2 days
post-transplant, followed by oral prednisolone acetate tapering to 20 mg
during the first month after transplantation, then 10 mg during months
2–3, and later 5 to 2.5 mg per day.
Cyclosporine A, sirolimus and azathioprine were used in a small group of
patients with longer time since transplant.