Glomerular filtration rate (GFR) is estimated by the abbreviated Modification of Diet in Renal Disease (MDRD) Study equation.11 Delayed graft function (DGF) was defined as the need for renal replacement therapy within 7 days post-transplant. Diagnosis of post-transplant DM was made according to international consensus guidelines.12 Hypercholesterolaemia was defined as total cholesterol greater than 5.8 mmol/L (224 mg/dL) or requiring a lipid-lowering agent. Ratio of donor kidney weight to recipient bodyweight (KW/BW) was used to estimate the donor/recipient size mismatch.13 The kidney weights (g) were recorded after a cold saline flush. The bodyweight (kg) of the recipient was measured on the morning
of the transplantation and recorded. Calculated KW/BW ratios were expressed as g/kg. Our patients were basically put on triple immunosuppressive therapy with either tacrolimus or Neoral cyclosporine (Novartis, Opaganib purchase Basel, Switzerland), concomitantly with prednisolone and azathioprine therapy. All patients received 500 mg
of methylprednisolone at induction. This was followed by i.v. hydrocortisone 100 mg every 6 h for 3 days and followed by oral prednisolone 30 mg daily. The dose of prednisolone was gradually tapered after the first month at a rate of 2.5 mg every 2 weeks then maintained at 7.5 mg daily. Azathioprine was given at a dose of 1.5 mg/kg daily from day 1 after transplant. Selleckchem RAD001 Cyclosporine (CsA) was initially given p.o. as a loading dose of 10 mg/kg within 12 h of surgery and then 5 mg/kg b.i.d. An abbreviated formula based on limited sampling strategy was used in this study to estimate the CsA area under 12 h concentration–time curve (AUC0–12). Calculation of CsA AUC0–12 was based on the formula: 452.4 + C0 × 17.5 + C1.5 × 1.89 (C0: CsA trough level; C1.5: 1.5 h post-dose CsA level).14 The dose of CsA was gradually titrated to maintain the abbreviated AUC0–12 at approximately 6000–8000 ng × h/mL
in the first 3 months post-transplant and 4000–6000 ng × h/mL from 3 months post-transplant onwards. On the other hand, tacrolimus was given p.o. with a loading dose of 0.3 mg/kg within 12 h of surgery and then 0.15 mg/kg b.i.d. Abbreviated tacrolimus AUC0–12 monitoring was used. Calculation of tacrolimus AUC0–12 was by the formula: 16.2 + C2 × 2.4 + C4 × 5.9 (C2: 2 h post-dose tacrolimus level; C4: 4 h post-dose tacrolimus ADP ribosylation factor level). Based on a previous pilot study in stable patients on tacrolimus in our centre, AUC0–12 value was kept at approximately 100–150 ng × h/mL in the first 3 months and at approximately 80–100 ng × h/mL after 3 months.15 Some of our patients have received either basiliximab (Simulect; Novartis, Switzerland) or daclizumab (Zenapax; Roche Laboratories, Nutley, NJ, USA) during induction therapy since 2001. Basiliximab was given at a dose of 20 mg approximately 2 h before transplantation and the second dose was given 4 days after transplantation.