title: Cyclosporine-based immunosuppressive strategies for kidney recipients: interim analysis of German data from the Multinational Observational Study (MOST).
abstract: BACKGROUND
  We collected data from kidney recipients with a functioning graft at German kidney transplant centers in order to analyze the efficacy of various cyclosporine (CsA)-based immunosuppressive strategies, the effects of different perioperative and maintenance regimens, and the impact of donor source on clinical outcome.
  
  
  METHODS
  As part of the ongoing prospective Multinational Observational Study in Transplantation (MOST), data for both prospective and retrospective analysis were collected from kidney recipients over 18 years bearing a functioning graft that was transplanted at 21 German kidney transplant centers between 1987 and 2002.
  
  
  RESULTS
  Data from 1223 renal graft recipients, including their CsA-based immunosuppressive regimens, were stratified as: 402 de novo patients (median 6.8 months posttransplant) and 821 patients on maintenance therapy (median 71 months posttransplant). Triple regimens with CsA + mycophenolate mofetil (MMF) + steroids (Ste) currently comprise the major perioperative immunosuppressive strategies in Germany (de novo 65%). IL-2 receptor antagonist (IL-2Ra) use is increasing (de novo 18%, maintenance 4%), while mono and dual regimen use de novo is declining (de novo 4%, maintenance 20%). Among 689 patients transplanted between 1987 and 2002 with outcome data, the mean incidence of acute rejection during the first posttransplant year was 21.6%. Rejection rates on initial therapy with CsA + MMF + Ste +/- antibodies (n = 517) averaged 17.8%.
  
  
  CONCLUSIONS
  Between 1987 and 2002, CsA-based immunosuppression combined with MMF and Ste became the most commonly used strategy for both initial and maintenance therapy after kidney transplantation in Germany, yielding the low acute rejection rates particularly when combined with IL-2Ra.
authors.affiliation: Department Internal Medicine/Nephrology, Nephrological Center Niedersachsen, Muenden, Germany. v.kliem@awogsd.de
authors.forename: V
authors.initials: V
authors.lastname: Kliem
authors.forename: L
authors.initials: L
authors.lastname: Fritsche
authors.forename: H
authors.initials: H
authors.lastname: Haller
authors.forename: B
authors.initials: B
authors.lastname: Suwelack
authors.forename: D
authors.initials: D
authors.lastname: Abendroth
authors.forename: P
authors.initials: P
authors.lastname: Fornara
authors.forename: F
authors.initials: F
authors.lastname: Pietruck
authors.forename: U
authors.initials: U
authors.lastname: Frei
authors.forename: J
authors.initials: J
authors.lastname: Donauer
authors.forename: A E
authors.initials: AE
authors.lastname: Lison
authors.forename: U
authors.initials: U
authors.lastname: Michel
authors.forename: B
authors.initials: B
authors.lastname: Ulbricht
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005858:Germany; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods / Q000639:trends; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D016853:Muromonab-CD3 / Q000627:therapeutic use; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D016572:Cyclosporine