Immunosuppression for Dual Kidney Transplantation with Marginal Organs: The Old Is Better Yet

Immunosuppressive protocols in dual kidney transplantation (DKT) are based on calcinerurin inhibitors (CNI). We wonder whether a CNI‐free immunosuppression can improve outcome in older patients receiving a DKT with marginal donor organs. Thirty‐six were treated with CsA, MMF and prednisone (CsA group) and 42 with rATG, SRL, MMF and prednisone (SRL group). Incidence of delayed graft function and acute rejection was 44% and 11% in the CsA group, and 40% and 8% in the SRL group. CMV infection incidence was low in both protocols. Three‐year patient survival was 89% in the CsA and 76% in the SRL group. One‐ and 3‐year graft survival after censoring for dead with a functioning allograft was 94.2% and 94% in CsA and 95% and 90% in SRL, respectively. Renal function was similar in both groups whereas proteinuria was higher in the SRL group. Uninephrectomy due to graft thrombosis or urinary‐related complications was numerically higher in the SRL (21%) than in the CsA group (8%) (p = 0.13) and it was associated with renal failure and proteinuria. In DKT, a new induction immunosuppressive protocol based on rATG, SRL, MMF and prednisone does not offer any advantage in comparison to the old CsA, MMF and prednisone. This study comparing two immunosuppressive protocols in patients receiving dual kidney transplants from extended criteria donors found that a protocol with rATG and sirolimus offered no advantages over a cyclosporine‐based protocol.