Before the administration of ATG (1.5 mg/kg/day intravenously), chlorpheniramine and acetaminophen were given intravenously as a premedication. The dose of ATG was reduced by 50% in patients with thrombocytopenia (platelet count 50,000–75,000 per cubic millimeter) or neutropenia (absolute neutrophil count 2000–3000 per cubic millimeter). ATG was discontinued when the patiet developed severe thrombocytopenia (platelet count < 50,000 per cubic millimeter) or severe neutropenia (absolute neutrophil count < 2000 per cubic millimeter).
The maintenance immunosuppressants consisted of tacrolimus, mycophenolate mofetil, and seven-day methylprednisolone taper. Tacrolimus was initiated two days before kidney transplantation at a dose of 0.05 mg/kg twice a day, and the target trough level was 6–8ng/ml until one year post-transplant. Mycophenolate mofetil was given 750 mg twice a day in both groups. Methylprednisolone was administered at a dose of 500 mg intravenously on day 0, 250 mg on day 1, and 125 mg on day 2 and 3. Thereafter, a fast taper was carried out with oral prednisone in the first week post-transplant.
All recipients received oral doses of trimethoprim 80 mg-sulfamethoxazole 400 mg daily for six months for bacterial and Pneumocystis jiroveci prophylaxis. Valganciclovir was administered for cytomegalovirus (CMV) prophylaxis for six months when a seronegative recipient had kidney transplantation from a seropositive donor. For low-to-intermediate risk patients, CMV monitoring was performed on a weekly basis using CMV-PCR assay for preemptive treatment. If the viral load of CMV was more than 4.0 log in the CMV-PCR assay, intravenous ganciclovir or oral valganciclovir was administered until CMV viremia was eliminated. In addition, BKV-PCR assay was also done on a monthly basis for BKV monitoring.
The maintenance immunosuppressants consisted of tacrolimus, mycophenolate mofetil, and seven-day methylprednisolone taper. Tacrolimus was initiated two days before kidney transplantation at a dose of 0.05 mg/kg twice a day, and the target trough level was 6–8ng/ml until one year post-transplant. Mycophenolate mofetil was given 750 mg twice a day in both groups. Methylprednisolone was administered at a dose of 500 mg intravenously on day 0, 250 mg on day 1, and 125 mg on day 2 and 3. Thereafter, a fast taper was carried out with oral prednisone in the first week post-transplant.
All recipients received oral doses of trimethoprim 80 mg-sulfamethoxazole 400 mg daily for six months for bacterial and Pneumocystis jiroveci prophylaxis. Valganciclovir was administered for cytomegalovirus (CMV) prophylaxis for six months when a seronegative recipient had kidney transplantation from a seropositive donor. For low-to-intermediate risk patients, CMV monitoring was performed on a weekly basis using CMV-PCR assay for preemptive treatment. If the viral load of CMV was more than 4.0 log in the CMV-PCR assay, intravenous ganciclovir or oral valganciclovir was administered until CMV viremia was eliminated. In addition, BKV-PCR assay was also done on a monthly basis for BKV monitoring.
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