Use of Daclizumab in Preventing Delayed Graft Function in Non-heart Beating Donor Kidney Transplantation in Newcastle upon Tyne*

Introduction: Use of marginal kidneys, such as from non-heart beating donors (NHBD), offers the opportunity to compensate for the growing discrepancy for demand for kidneys and their availability from brain-stem dead donors. Such kidneys are prone to delayed graft function (DGF), which can be prolonged by nephrotoxic drugs including calcineurin inhibitors. This study aims to determine whether use of daclizumab (DZB) induction and delayed introduction of tacrolimus (TAC) can reduce the incidence of DGF without increasing the incidence of acute rejection. Methods: Randomised controlled trial with two groups: (A) DZB with TAC delayed until serum creatinine < 350μmol/l (4.0 mg/l) or biopsy-proven acute rejection; (B) introduction of TAC immediately post-transplant. Both groups also received mycophenolate mofetil and prednisolone. Machine perfusion and viability assessment based on flow characteristics and perfusate enzyme levels was used for all kidneys. Results: Immediate function in 53% of DZB and 13% of TAC group (p=0.02). Acute rejection in 22% of DZB group and 39% of TAC group (p=NS). Groups well matched demographically, although higher recipient cardiovascular risk score was observed in DZB group (5 vs. 3, p=0.01). Conclusion: Use of DZB with delayed introduction of TAC reduces the incidence of DGF in NHBD kidney transplantation, without increasing the incidence of acute rejection. This strategy may be beneficial in kidney transplantation from other forms of marginal donors.