title: Eight-year outcomes of 'the Cairo Kidney Centre sequential protocol'.
abstract: OBJECTIVE
  To describe the long-term results of a previously developed a sirolimus-based sequential immunosuppression protocol for kidney transplant comprising 2 phases: sirolimus + cyclosporine + prednisolone for 3 months followed by sirolimus + prednisolone + mycophenolate mofetil with steroid minimization the first year. Two-year outcomes of patients on this protocol (group A) showed equivalent patient and graft survival, yet with significantly better function, compared with those on cyclosporine + mycophenolate mofetil + prednisolone (group B).
  
  
  METHODS
  We report the 8-year outcomes in the same cohort (76 patients in group A and 37 in group B).
  
  
  RESULTS
  42% switched from group A to B versus 43% switching from B to A. Intent-to-treat patient survivals at 5 and 8 years were 88% and 85.5% for group A, and 78% and 73% for group B. Death-censored graft survivals were 93% for group A and 95% for group B. Graft function was significantly better at 8 years, with 91% of group A patients compared with 50% in group B having estimated glomerular filtration rates > 45 mL/min/1.73 m2, and a significantly lower incidence of chronic allograft nephropathy in the former. Secondary parameters including blood pressure control, new onset diabetes mellitus, proteinuria and other drug-related adverse events showed no significant differences between the groups.
  
  
  CONCLUSIONS
  The sirolimus-based sequential immunosuppression protocol was well tolerated in 58% of patients. The intent-to-treat and patients-ontherapy analyses revealed that it was equivalent to the widely used cyclosporine + mycophenolate mofetil + prednisolone protocol regarding patient and graft survival. It is associated with better graft function and lower incidence of chronic allograft nephropathy in 8 years' follow-up. The incidence of drug-related adverse reactions was not statistically different from those in the comparator.
authors.affiliation: From the Department of Internal Medicine, Cairo University; and the Cairo Kidney Centre, Cairo, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: Fayad
authors.forename: Emad
authors.initials: E
authors.lastname: William
authors.forename: Nasr
authors.initials: N
authors.lastname: Tawfik
authors.forename: Boulos
authors.initials: B
authors.lastname: Habashy
authors.forename: Hazem S
authors.initials: HS
authors.lastname: Abou-Youssef
authors.forename: Sameh
authors.initials: S
authors.lastname: Shokry
authors.forename: Soha
authors.initials: S
authors.lastname: Khalil
authors.forename: Ahmed
authors.initials: A
authors.lastname: Morsy
authors.forename: Rashad
authors.initials: R
authors.lastname: Barsoum
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065095:Calcineurin Inhibitors / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage; D004334:Drug Administration Schedule; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D004534:Egypt; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011183:Postoperative Complications / Q000276:immunology / Q000517:prevention & control; D011239:Prednisolone / Q000008:administration & dosage; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D016572:Cyclosporine; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011239:Prednisolone; D020123:Sirolimus