Trends in adult post-kidney transplant immunosuppressive use in Australia, 1991-2005.
OBJECTIVE
Kidney transplant outcomes have improved over the past 15 years, partly due to improvements in immunosuppression. We used data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry to examine trends in immunosuppressive use post transplant.


METHODS
All adult (recipient age 16+ years) kidney-only transplants performed in Australia from April 1991 to December 2005 were followed to graft loss or December 2005. Immunosuppressive use at induction, 1, 3 and 5 years post transplant were analysed by transplant cohort.


RESULTS
Calcineurin-inhibitors (CNI) were used in most recipients for induction and maintenance immunosuppression, with increasing tacrolimus use. Induction cyclosporin dose increased since 2001 (from 5.8 to 7.9 mg/kg per day), but maintenance cyclosporin and tacrolimus dose decreased (from 3.8 to 3.0 mg/kg per day cyclosporin at 1 year post transplant). CNI-free induction increased since 2002 (from 1.4% to 8.4%), while CNI-free maintenance increased throughout the study period. Mycophenolates were the predominant antimetabolite used. Steroid-free maintenance decreased (from 22.7% to 8.7% at 1 year post transplant), as did median prednisolone doses (from 0.12 to 0.09 mg/kg per day at 1 year post transplant). Sirolimus or everolimus are increasingly used for CNI-sparing rather than as antimetabolites substitutes. OKT3 or antithymocyte globulin induction decreased, while anti-CD25 antibody usage increased from 9.5% to 57.1% since 2000.


CONCLUSIONS
There is a trend to more potent induction immunosuppression with tacrolimus, mycophenolates and anti-CD-25 antibodies, but with CNI avoidance or minimization during maintenance phase. While steroid avoidance/cessation decreased, maintenance steroid dose has also decreased. Anti-CD25 antibodies are now used in >50% of recipients.
Chang
Sean H
SH
Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Queen Elizabeth Hospital, Woodville South, SA 5011, Australia. sean@anzdata.org.au
Russ
Graeme R
GR
Chadban
Steven J
SJ
Campbell
Scott
S
McDonald
Stephen P
SP
D000284:Administration, Oral; D000328:Adult; D000906:Antibodies / Q000627:therapeutic use; D000963:Antimetabolites / Q000627:therapeutic use; D001315:Australia; D001379:Azathioprine / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000627:therapeutic use; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000378:metabolism / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D053645:Interleukin-2 Receptor alpha Subunit / Q000276:immunology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D009520:New Zealand; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011239:Prednisolone / Q000627:therapeutic use; D011494:Protein Kinases / Q000187:drug effects; D012042:Registries; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
D000906:Antibodies; D000963:Antimetabolites; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D053645:Interleukin-2 Receptor alpha Subunit; D013256:Steroids; D016572:Cyclosporine; D000068338:Everolimus; D011239:Prednisolone; D011494:Protein Kinases; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D009173:Mycophenolic Acid; D001379:Azathioprine; D020123:Sirolimus; D016559:Tacrolimus