title: A comparison of discharge immunosuppressive drug regimens in primary cadaveric kidney transplantation.
abstract: BACKGROUND
  Finding the best combination of immunosuppression is an important challenge in kidney transplantation. Current short-term (1- and 3-year) allograft survival is quite good, making it difficult to determine differences in therapeutic regimens without large sample sizes. Using data from the United Network for Organ Sharing/Organ Procurement and Transplantation Network database, the current study provides substantial statistical power to analyze the outcomes for different immunosuppressive regimens.
  
  
  METHODS
  To compare the effects of four discharge regimens (cyclosporine and azathioprine [CYA+AZA], CYA and mycophenolate mofetil [MMF], tacrolimus [TAC]+AZA, and TAC+MMF) on long-term survival, a multivariate Cox regression analysis was conducted on 19246 primary cadaveric kidney transplants during 1995 to 1998.
  
  
  RESULTS
  Compared with CYA+AZA, the combination of CYA+MMF was associated with a 10% reduced risk of graft loss (relative risk [RR] 0.90, 95% confidence limit [CL] 0.84-0.96, P<0.001), whereas TAC+AZA was associated with an 18% reduced risk (RR 0.82, 95% CL 0.67-1.005, P=0.06) and TAC+MMF with a 20% reduced risk of graft loss (RR 0.80, 95% CL 0.71-0.89, P<0.001). All three regimens benefited patients regardless of delayed graft function (DGF) or early acute rejection status. In addition, in the absence of DGF, the combinations of CYA+MMF, TAC+AZA, and TAC+MMF were associated with a reduced risk of mortality compared with CYA+AZA.
  
  
  CONCLUSIONS
  The major finding of this study was improved graft and patient survival associated with TAC+MMF and CYA+MMF in patients with or without DGF or early acute rejection.
authors.affiliation: Research Department, United Network for Organ Sharing, Richmond, VA, USA. cherikws@unos.org
authors.forename: Wida S
authors.initials: WS
authors.lastname: Cherikh
authors.forename: H
authors.initials: H
authors.lastname: Myron Kauffman
authors.forename: Jude
authors.initials: J
authors.lastname: Maghirang
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Bleyer
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D001379:Azathioprine / Q000008:administration & dosage; D002102:Cadaver; D016572:Cyclosporine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage; D016559:Tacrolimus / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine; D016559:Tacrolimus