Immunosuppression is tailored according to an assessment of the patients’ immunological risk. It is more intense in the first few weeks and months when the risk of acute rejection is greatest, but needs to continue long-term. After transfer back to local units post-transplantation, the local nephrology team adjusts immunosuppression.<\/p>\n
This page deals with immunosuppression in the first few months. There are sub-pages on Tacrolimus levels<\/a>, on Steroid avoidance and withdrawal<\/a>, and on Long-term immunosuppression<\/a>.<\/p>\n See also the timepoint summaries under Outpatient Management<\/a> indicating expectations at 3, 6 and 9 months.<\/p>\n We divide patients into high, standard and low immunological risk categories. The clinical relevance of this is that induction differs as per group.<\/p>\n We base ‘high’ immunological risk on the presence of donor-specific anti-HLA antibodies (DSA<\/a>). These patient should receive ATG<\/a> as induction.<\/p>\n Transplantation will usually not proceed if a full crossmatch is positive, except in very unusual and carefully planned circumstances. All positive crossmatch or DSA positive cases should be discussed with the H&I team to determine risk and their assessment on pathogenicity of the antibody. Standard risk patients will receive basiliximab<\/a> induction. Low risk patients will not receive induction, other than IV methylprednisolone that all patients receive.<\/p>\n For details on the ATG induction regime please see here<\/a>. Indicates presence of donor-specific antibodies (DSA) measured by solid phase assay with or without a corresponding positive crossmatch.<\/p>\n All other patients not fulfilling these criteria should not receive antibody induction. There will still receive IV methylprednisolone like all other patients however.<\/p>\n <\/p>\n This regimen applies to all recipients with standard immunological risk.<\/p>\n From Sep 2018, Edinburgh switched to use the Adoport\u00ae<\/sup> formulation of Tacrolimus in place of Prograf\u00ae<\/sup>. Formulations of Tacrolimus are not interchangeable and must be prescribed as a specific proprietary product. <\/em>The age for reducing the standard MMF dose was also reduced from 65 to 60.<\/em><\/p>\nAssessing immunological risk<\/span><\/strong><\/span><\/h3>\n
High risk: positive DSA or flow (FACS) crossmatch<\/span><\/strong><\/span><\/h3>\n
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Standard risk<\/span><\/strong><\/span><\/h3>\n
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Low risk<\/span><\/strong><\/span><\/h3>\n
Immunosuppressive regimen<\/span><\/strong><\/span><\/h3>\n