Background Calcineurin inhibitors (CNI) are fundamental part of maintenance immunosuppresion in kidney transplantation. Current recommendations for the clinical practice1,2 have led to the change of initial CNI in our centre during the last years.
Purpose The use of tacrolimus as primary CNI has increased from 48% of patients in 2008 to 90% of patients in 2013 in our centre. The aim of our retrospective analysis was to analyse the impact of initial CNI on short term graft outcomes.
Material and methods 320 kidney transplant recipients were included into the study. Tacrolimus (TAC) as initial CNI was administered in 171 patients and cyclosporine A (CsA) in 149 patients transplanted in 2008–2013 period. CNI were combined with corticosteroids and mycophenolate mophetil or mycophenolic acid in all patients, induction immunossuppressive therapy was not applied. Statistical analysis was performed using Pearson’s χ2 test, Fisher’s exact test and Kaplan-Meier survival analysis.
Results Mean follow up of the patients was 201.7 weeks in TAC patients and 186.8 weeks in CsA patients (ns). Early acute rejection was confirmed in 54.6% of patients using TAC and 45.4% of patients on CsA (ns). Graft survival at 1 and 3 years was 95.7% and 94.0% in TAC group and 85.5% and 84.2% in CsA group (p = 0.006 and p = 0.015). When controlled for age, degree of sensitisation and number od HLA mismatches, the type of CNI was independent predictor for graft survival (HR 2.63 for TAC, p = 0,011). Overall patient survival was significantly better in TAC group (p < 0.001), even when controlled for age (HR 3.45, p = 0.002). Interestingly, in a subgroup of patients older than 50 years the graft survival in both treatment groups was not different.
Conclusion Our kidney transplant recipients in the TAC group had higher 1-year graft survival. In our opinion, tacrolimus should be preffered CNI especially in younger kidney transplant recipients.
References and/or Acknowledgements
Ekberg H, Tedesco-Silva H, Demirbas A et al. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med 2007;357:2562–2575
KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients, Am J Transp 2009; 9(Suppl 3):S10-S13
References and/or AcknowledgementsNo conflict of interest.
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