BACKGROUND: Few studies have evaluated the effect of different immunosuppressive strategies on long-term kidney transplant outcomes. Moreover, as they were usually based on historical data, it was not possible to account for the presence of pretransplant donor-specific human-leukocyte antigen antibodies (DSA), a currently recognized risk marker for impaired graft survival. The aim of this study was to evaluate to what extent frequently used initial immunosuppressive therapies increase graft survival in immunological low-risk patients. METHODS: We performed an analysis on the PROCARE cohort, a Dutch multicentre study including all transplantations performed in the Netherlands between 1995 and 2005 with available pretransplant serum (n = 4724). All sera were assessed for the presence of DSA by a luminex single-antigen bead assay. Patients with a previous kidney transplantation, pretransplant DSA or receiving induction therapy were excluded from the analysis. RESULTS: Three regimes were used in over 200 patients: cyclosporine (CsA)/prednisolone (Pred) (n = 542), CsA/mycophenolate mofetil (MMF)/Pred (n = 857) and tacrolimus (TAC)/MMF/Pred (n = 811). Covariate-adjusted analysis revealed no significant differences in 10-year death-censored graft survival between patients on TAC/MMF/Pred therapy (79%) compared with patients on CsA/MMF/Pred (82%, P = 0.88) or CsA/Pred (79%, P = 0.21). However, 1-year rejection-free survival censored for death and failure unrelated to rejection was significantly higher for TAC/MMF/Pred (81%) when compared with CsA/MMF/Pred (67%, P < 0.0001) and CsA/Pred (64%, P < 0.0001). CONCLUSION: These results suggest that in immunological low-risk patients excellent long-term kidney graft survival can be achieved irrespective of the type of initial immunosuppressive therapy (CsA or TAC; with or without MMF), despite differences in 1-year rejection-free survival.
BACKGROUND: Few studies have evaluated the effect of different immunosuppressive strategies on long-term kidney transplant outcomes. Moreover, as they were usually based on historical data, it was not possible to account for the presence of pretransplant donor-specific human-leukocyte antigen antibodies (DSA), a currently recognized risk marker for impaired graft survival. The aim of this study was to evaluate to what extent frequently used initial immunosuppressive therapies increase graft survival in immunological low-risk patients. METHODS: We performed an analysis on the PROCARE cohort, a Dutch multicentre study including all transplantations performed in the Netherlands between 1995 and 2005 with available pretransplant serum (n = 4724). All sera were assessed for the presence of DSA by a luminex single-antigen bead assay. Patients with a previous kidney transplantation, pretransplant DSA or receiving induction therapy were excluded from the analysis. RESULTS: Three regimes were used in over 200 patients: cyclosporine (CsA)/prednisolone (Pred) (n = 542), CsA/mycophenolate mofetil (MMF)/Pred (n = 857) and tacrolimus (TAC)/MMF/Pred (n = 811). Covariate-adjusted analysis revealed no significant differences in 10-year death-censored graft survival between patients on TAC/MMF/Pred therapy (79%) compared with patients on CsA/MMF/Pred (82%, P = 0.88) or CsA/Pred (79%, P = 0.21). However, 1-year rejection-free survival censored for death and failure unrelated to rejection was significantly higher for TAC/MMF/Pred (81%) when compared with CsA/MMF/Pred (67%, P < 0.0001) and CsA/Pred (64%, P < 0.0001). CONCLUSION: These results suggest that in immunological low-risk patients excellent long-term kidney graft survival can be achieved irrespective of the type of initial immunosuppressive therapy (CsA or TAC; with or without MMF), despite differences in 1-year rejection-free survival.
Authors: Sebastiaan Heidt; Geert W Haasnoot; Marian D Witvliet; Marissa J H van der Linden-van Oevelen; Elena G Kamburova; Bram W Wisse; Irma Joosten; Wil A Allebes; Arnold van der Meer; Luuk B Hilbrands; Marije C Baas; Eric Spierings; Cornelis E Hack; Franka E van Reekum; Arjan D van Zuilen; Marianne C Verhaar; Michiel L Bots; Adriaan C A D Drop; Loes Plaisier; Marc A J Seelen; Jan-Stephan Sanders; Bouke G Hepkema; Annechien J A Lambeck; Laura B Bungener; Caroline Roozendaal; Marcel G J Tilanus; Christina E Voorter; Lotte Wieten; Elly M van Duijnhoven; Marielle A C J Gelens; Maarten H L Christiaans; Frans J van Ittersum; Shaikh A Nurmohamed; Neubury M Lardy; Wendy Swelsen; Karlijn A M I van der Pant; Neelke C van der Weerd; Ineke J M Ten Berge; Frederike J Bemelman; Andries Hoitsma; Paul J M van der Boog; Johan W de Fijter; Michiel G H Betjes; Henny G Otten; Dave L Roelen; Frans H J Claas Journal: Am J Transplant Date: 2019-07-01 Impact factor: 8.086
Authors: Wilfried Gwinner; Annika Karch; Jan H Braesen; Abedalrazag A Khalifa; Jochen Metzger; Maarten Naesens; Elisabet Van Loon; Dany Anglicheau; Pierre Marquet; Klemens Budde; Mareen Matz; Wolfgang Arns; Michael Fischereder; Antje Habicht; Ute Eisenberger; Anja Mühlfeld; Martin Busch; Michael Wiesener; Irina Scheffner; Armin Koch Journal: Transplant Direct Date: 2022-04-12