Anti-CD25 monoclonal antibody coverage allows for calcineurin inhibitor "holiday" in solid organ transplant patients with acute renal dysfunction

Background. Solid organ transplant (Tx) patients on calcineurin inhibitors (CNI) can develop acute renal dysfunction (ARD), which could be improved by reducing or withholding ("holiday") CNI dose. Methods. We used anti-CD25 monoclonal antibodies to prevent acute rejection in 11 adult Tx patients (7 heart, 2 liver, 2 heart-renal Tx), requiring a CNI "holiday" because of 15 events of ARD after the initial postTx hospitalization. An event of ARD was defined as an increase in serum creatinine (Scr) > 25% vs. baseline. The CNI "holiday" was implemented until Scr had decreased to baseline. Basiliximab was used in 7 patients (11 events), and daclizumab was used in 4 patients (4 events). Results. The CNI "holiday" was implemented over 21+/-51. days. Anti-CD25 mAb were well tolerated with no episodes of acute rejection. Scr (mumol/liter) increased from 145+/-48 to 301+/-92 (P<0.0001), and decreased to 143+/-55 with the CNI "holiday." Conclusions. Our results suggest that a CNI "holiday" may improve ARD after solid organ Tx without rejection under anti-CD25 mAb coverage.