Immunosuppression and Prophylaxis
Basiliximab (20 mg at days 0 and 4 of opera­tion) or anti-thymocyte globulin (ATG; for high-risk patients, 3 mg/kg during operation and 1,5 mg/kg at postoperative days 1 and 2) were used as induction therapy. Methylprednisolone 1000 mg was given intra-operatively. Methylprednisolone dose was decreased by half every day and 20 mg oral prednisolone was started on the 6th postoperative day for daily use. Oral prednisolone dosage was reduced gradually to reach 5 mg a day in the first year after transplantation. Calcineurin inhibitors (tacrolimus or cyclosporin) and mycophenolate mofetil (MMF; 2 g /day in two divided doses) or mycophenolate sodium (MMF; 1440 mg/day, in two divided doses) were used as mainte­nance immunosuppression therapy. MMF was used as 600 mg/m2 in two divided doses in children. We considered both mycophenolate mofetil and mycophenolate sodium in doses described above as the same drugs in our study. Everolimus was used in only one case (plasma level of the drug was targeted as 8-10 mg/dl). Trimethoprim/sulfamethoxazole and valganci­clovir (450 mg a day) was prescribed for Pneumocystis jirovecii and cytomegalovirus (CMV) prophylaxis for 6 months after the trans­plantation. Acute rejection was diagnosed by kidney biopsy. The acute cellular rejection was treated with intravenous pulse methylpredniso­lone or ATG depending on the severity of the rejection. Plasmapheresis was added for acute humoral rejection. Delayed graft function (DGF) was described as a need for hemodialysis in the first week of kidney transplantation.