title: Five-year outcomes after a change from a cyclosporin-based to a 'low-dose' tacrolimus-based primary immunosuppression regimen for incident kidney transplants--the Glasgow experience.
abstract: In January 2007, our centre changed from a cyclosporin (CyA)/azathioprine (Aza)/ prednisolone (Pred) primary immunosuppression regimen (with basiliximab induction and mycophenolate mofetil [MMF] for those at immunologically high risk) to a tacrolimus (Tac) (low dose)/MMF/Pred regimen with basiliximab induction, following presentation of Symphony trial results. This analysis assesses the impact of this change on 5-year outcomes. Three hundred consecutive renal-only transplants were identified: 140 from the 2005-06 era and 160 from the 2007-08 era. The proportions of living donor (37.5 vs. 22.9%; p = 0.04) and donors after circulatory death (11.9 vs. 5.0%; p = 0.03) were higher in the 2007-08 cohort. Five-year actuarial patient survival was higher in the 2007-08 cohort (96.8 vs. 87.1%; p = 0.003), with a trend toward higher 5-year transplant survival (84.7 vs. 76.3%; p = 0.08). Estimated glomerular filtration rate (eGFR) was higher than in the 2005-06 era at 1 (53.5 vs. 44.5 ml/min/1.73m2; p = 0.0006) and 3 years (50.9 vs. 43.4 ml/min/1.73m2; p = 0.02), with a trend toward higher eGFR at 5 years (41.8 vs. 49.6 ml/min/1.73m2; p = 0.09). Differences were consistent when living donor and deceased donor transplants were analysed separately. In a "real world" population, a change from a CyA-based to a Tac (low-dose)/MMF/Pred primary immunosuppression regimen has been associated with better 5-year outcomes.
authors.affiliation: Glasgow Renal and Transplant Unit, Western Infirmary, Glasgow, United Kingdom. colin.geddes@ggc.scot.nhs.uk
authors.forename: Colin C
authors.initials: CC
authors.lastname: Geddes
authors.forename: Alan G
authors.initials: AG
authors.lastname: Jardine
authors.forename: David
authors.initials: D
authors.lastname: Kingsmore
authors.forename: Enric
authors.initials: E
authors.lastname: Murio
authors.forename: Laura
authors.initials: L
authors.lastname: Buist
authors.forename: Vlad
authors.initials: V
authors.lastname: Shumeyko
authors.forename: Neal
authors.initials: N
authors.lastname: Padmanabhan
authors.forename: Conal
authors.initials: C
authors.lastname: Daly
authors.forename: Ellon
authors.initials: E
authors.lastname: McGregor
authors.forename: Margaret
authors.initials: M
authors.lastname: McMillan
authors.forename: Siobhan
authors.initials: S
authors.lastname: McManus
authors.forename: R Stuart C
authors.initials: RS
authors.lastname: Rodger
authors.forename: Marc
authors.initials: M
authors.lastname: Clancy
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000401:mortality*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000097:blood; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000188:drug therapy / Q000401:mortality; D012606:Scotland / Q000453:epidemiology; D016559:Tacrolimus / Q000008:administration & dosage* / Q000097:blood; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus