The standard immunosuppression was performed by a triple combination of methylprednisolone, tacrolimus (target C0 levels of 7–10 ng/mL), and mycophenolate mofetil. In the case of tacrolimus-related side effects, it was switched to cyclosporine A (target C0 level of 150–200 ng/mL). Mycophenolate mofetil was switched to enteric-coated mycophenolate sodium or azathioprine in the case of gastrointestinal side effects.
Elective recipients received preoperative selective digestive decontamination (nonabsorbable antibiotics and oral amphotericin B), followed by extended-spectrum perioperative antibacterial prophylaxis with piperacillin–tazobactam for five days. Levofloxacin was used alternatively for patients with allergy against β-lactam agents.
Patients with high risk for cytomegalovirus (CMV) infection (seropositive donors, seronegative recipients) received antiviral prophylaxis (valganciclovir) for 3–6 months. A pre-emptive approach based on a weekly polymerase chain reaction surveillance was followed otherwise, and therapy was started only after detection of CMV viremia above a lower limit of quantification greater than 250 IU/mL before clinical symptoms.
At least once per week a routine, microbiological screening was performed (including Candida surveillance cultures from swabs of the throat, perineum, and urine cultures). A more-often sampling was performed if indicated by the critical care specialist.
Elective recipients received preoperative selective digestive decontamination (nonabsorbable antibiotics and oral amphotericin B), followed by extended-spectrum perioperative antibacterial prophylaxis with piperacillin–tazobactam for five days. Levofloxacin was used alternatively for patients with allergy against β-lactam agents.
Patients with high risk for cytomegalovirus (CMV) infection (seropositive donors, seronegative recipients) received antiviral prophylaxis (valganciclovir) for 3–6 months. A pre-emptive approach based on a weekly polymerase chain reaction surveillance was followed otherwise, and therapy was started only after detection of CMV viremia above a lower limit of quantification greater than 250 IU/mL before clinical symptoms.
At least once per week a routine, microbiological screening was performed (including Candida surveillance cultures from swabs of the throat, perineum, and urine cultures). A more-often sampling was performed if indicated by the critical care specialist.
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