Resumen

BORROTO DIAZ, Gerardo  y  GUERRERO DIAZ, Carlos. Induction immunosuppression in renal transplantation at "Hermanos Ameijeiras" Hospital. 1984-2012. Rev cubana med [online]. 2013, vol.52, n.2, pp. 88-98. ISSN 0034-7523.

Introduction: immunosuppression induction is essential in successful kidney transplant. It is aimed at preventing acute rejection and delayed graft function and is designed as a strategy for the beginning of the transplant in which complications are much more common. Objective: to present the different protocols of immunosuppression induction used by the transplant staff of "Hermanos Ameijeiras" Hospital, according to the type of donor (alive or dead), and the frequency of clinical complications. Methods: a descriptive retrospective study was carried out which covered all the kidney transplant done since this activity began in March 1984 until it continued to November 2012. Four stages were distinguished: 1984-1990, 1991-1996, 1997-2004 and 2005-2012. The treatment with Prednisone and Azatioprine in the dead donor predominated in the two first stages. The combination of three drugs: Cyclosporin A (Sandimmune), Prednisone and Azatioprine was only used in transplants in which dead donors were considered high risk. Both protocols were accompanied by high rejection frequencies and acute tubular necrosis in the period 1997-2004. Conclusions: the triple therapy with Cyclosporin A (Neoral), Prednisone and Mycophenolate Mophetil provided low rejection rates and acute tubular necrosis even when the graft came from both an alive donor or a dead one. The quadruple sequential therapies constituted an accepted treatment to diminish rejection in risk patients. The treatment with Prednisone and Azatioprine and Cyclosporin in Sandimmune formulation, with Prednisone and Azatioprine, or with Prednisone, according to the results obtained, do not constitute satisfactory protocols for immunosuppression in kidney transplant at present.

Palabras clave : protocol; immunosuppression induction; kidney transplant; rejection; acute tubular necrosis.

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