title: Sirolimus with neoral versus mycophenolate mofetil with neoral is associated with decreased renal allograft survival.
abstract: To evaluate the association between a regimen of cyclosporine microemulsion (CsA) + sirolimus (Rapa) treatment versus CsA and mycophenolate mofetil (MMF) and renal allograft survival, we analyzed 23 016 primary recipients reported to the Scientific Registry of Transplant Recipients between January 1, 1998 and July 26, 2003. Univariate Kaplan-Meier analysis and multivariate Cox proportional hazard models correcting for demographic and clinical covariates were used to estimate the relative risks for CsA+Rapa versus CsA+MMF-treated patients reaching study endpoints. Subgroup analyses were conducted for recipient ethnicity and donor type. CsA+Rapa was associated with significantly lower graft survival (74.6% vs. 79.3% at 4 years, p = 0.002) and death-censored graft survival (83.7% vs. 87.2%, p = 0.003) compared to CsA+MMF. In multivariate analyses, CsA+Rapa was associated with a significantly increased risk for graft loss, death-censored graft loss and decline in renal function (HR = 1.22, p = 0.002; HR = 1.22, p = 0.018 and HR = 1.25, p < 0.001, respectively). Similar results were obtained in recipient ethnicity and donor type subgroups. In summary, CsA+Rapa was associated with significantly worse graft survival and death-censored graft survival compared to CsA+MMF, and likely reflects full-dose CsA +Rapa. Outcomes regarding alternative strategies of Rapa utilization with reduced CsA, with alternative agents or with no calcineurin inhibitor cannot be extrapolated from these data.
authors.affiliation: Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA. meierhu@medicine.ufl.edu
authors.forename: Herwig-Ulf
authors.initials: HU
authors.lastname: Meier-Kriesche
authors.forename: Bettina J
authors.initials: BJ
authors.lastname: Steffen
authors.forename: Alice H
authors.initials: AH
authors.lastname: Chu
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Loveland
authors.forename: Robert D
authors.initials: RD
authors.lastname: Gordon
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Morris
authors.forename: Bruce
authors.initials: B
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D002102:Cadaver; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D012042:Registries; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D016019:Survival Analysis; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D016572:Cyclosporine; D009173:Mycophenolic Acid; D020123:Sirolimus