title: Long-term renal allograft function on a tacrolimus-based, pred-free maintenance immunosuppression comparing sirolimus vs. MMF.
abstract: It is not known how different steroid-free immunosuppressive combinations affect renal graft survival and long-term kidney transplant function. Here we sought to compare the impact on graft survival and long-term graft function of two tacrolimus (Tac)-based, prednisone-free maintenance immunosuppressive protocols: Tac/Mycophenolate Mofetil (MMF) vs. Tac/Sirolimus (SRL). Renal transplant patients given induction therapy with IL2-RA and methylprednisolone on days 0, 1 and 2 post-transplant were prospectively randomized to two maintenance immunosuppressive regimens with Tac/MMF (n = 45) or Tac/SRL (n = 37). During the 3-year follow-up the following data were collected: patient survival, renal allograft survival, incidence of acute rejection and glomerular filtration rate (GFR) at different time-points post-transplant. Cumulative graft survival was significantly different in the two groups: one kidney loss in the Tac/MMF vs. six kidney losses in the Tac/SRL (log-rank test p = 0.04). GFR at different time-points post-transplant was consistently and statistically better in the Tac/MMF than in the Tac/SRL group. The slope of GFR decline per month was flatter in the Tac/MMF than in the Tac/SRL group. This study showed that renal graft survival and graft function were significantly lower in the combination of Tac/SRL than Tac/MMF.
authors.affiliation: Division of Nephrology, Department of Medicine, Northwestern University, Chicago, Illinois, USA. l-gallon@northwestern.edu
authors.forename: L
authors.initials: L
authors.lastname: Gallon
authors.forename: N
authors.initials: N
authors.lastname: Perico
authors.forename: B D
authors.initials: BD
authors.lastname: Dimitrov
authors.forename: J
authors.initials: J
authors.lastname: Winoto
authors.forename: G
authors.initials: G
authors.lastname: Remuzzi
authors.forename: J
authors.initials: J
authors.lastname: Leventhal
authors.forename: F
authors.initials: F
authors.lastname: Gaspari
authors.forename: D
authors.initials: D
authors.lastname: Kaufman
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000145:classification / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D020123:Sirolimus / Q000009:adverse effects / Q000494:pharmacology*; D016559:Tacrolimus / Q000009:adverse effects / Q000494:pharmacology*; D013997:Time Factors; D014184:Transplantation, Homologous / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus