Steroid-free Tacrolimus Monotherapy After Pretransplantation Thymoglobulin or Campath and Laparoscopy in Living Donor Renal Transplantation H.P. Tan, D. Kaczorowski, A. Basu, J. McCauley, A. Marcos, J. Donaldson, M. Unruh, P. Randhawa, A. Zeevi, and R. Shapiro ABSTRACT Living donor renal transplantation was performed under a regimen of recipient pretreat- ment and low-dose postoperative immunosuppression with subsequent weaning. From October 9, 2002, to December 31, 2004, 196 consecutive, unselected laparoscopic live donor nephrectomies resulting in 196 living donor renal transplantations were performed. Recipients were pretreated with rabbit antithymocyte globulin (thymoglobulin; 24 patients or [12%]) or Campath 1H (alemtuzumab; 166 patients [85%]), or were not in protocol (6 patients [3%]), and were given postoperative steroid-free low-dose tacrolimus immuno- suppressive monotherapy with subsequent weaning. There was no donor mortality. Major and minor donor morbidities were 2.6% and 4.2%, respectively. Laparoscopic live donor nephrectomy recipient outcomes with a mean follow-up of 401 days included (1) recipient and graft survival of 99.0% and 97.4%, respectively; (2) no ureteral stenosis; (3) 0.5% delayed graft function, from recurrent focal segmental glomerulosclinosis; and (4) no vascular thrombosis. The incidence of acute rejection at 30, 90, and 401 days was 1.5%, 3.8%, and 11.2% (all 196 recipients), 0%, 25%, and 29.2% (thymoglobulin recipients), and 1.8%, 3.9%, and 8.4% (Campath 1H recipients), respectively. Sixty-six patients (33.7%) are receiving spaced-dose immunosuppressive monotherapy. The mean creatinine con- centration in all recipients was 1.5  1.1 mg/dL. There were no instances of cytomegalo- virus tissue invasive disease or posttransplantation lymphoproliferative disease. The incidence of new-onset posttransplantation insulin-dependent diabetes was 0.5%. At current follow-up, the use of Campath 1H rather than thymoglobulin for pretreatment seems to have significantly improved the efficacy of our regimen. L ACK OF DONOR ORGANS and the necessity of subjecting patients to the toxicities associated with immunosuppression are currently major problems in the field of solid-organ transplantation. Increased use of organs from living donors is the most immediately available route for alleviating the current shortage of donor organs for transplantation. Laparoscopic live donor nephrectomy (LLDN) was introduced in 1995 as a means of increasing organ donation by minimizing potential disincentives to donors. 1 Since then, the use of LLDN has been shown to cause less postoperative pain, permit shorter hospital stays, and enable more rapid recovery compared with open operation. 2,3 Laparoscopic live donor nephrectomy has provided equivalent functional results as well. 4 For these reasons, LLDN seems to have increased the number of living donor renal transplantations 5 and has been broadly adopted by transplant centers worldwide. The development of increasingly potent immunosuppres- sive regimens has markedly decreased the rate of acute cellular rejection (ACR), but the risks for infectious com- plications, malignancy, metabolic adverse effects, and other immunosuppressive drug toxicities persist. These observa- tions, along with the realization that heavy early posttrans- From the Starzl Transplantation Institute, University of Pitts- burgh Medical Center, Pittsburgh, Pennsylvania. Address reprint requests to Henkie P. Tan, MD, PhD, Univer- sity of Pittsburgh Medcal Center, Starzl Transplantation Institute, 3459 Fifth Ave, MUH N758, Pittsburgh, PA 15213. E-mail: tanhp@upmc.edu © 2005 by Elsevier Inc. All rights reserved. 0041-1345/05/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2005.10.020 Transplantation Proceedings, 37, 4235– 4240 (2005) 4235