Details

Autor(en) / Beteiligte

• Michielsen, Laura A
• van Zuilen, Arjan D
• Verhaar, Marianne C
• Wisse, Bram W
• Kamburova, Elena G
• Joosten, Irma
• Allebes, Wil A
• van der Meer, Arnold
• Baas, Marije C
• Spierings, Eric
• Hack, Cornelis E
• van Reekum, Franka E
• Bots, Michiel L
• Drop, Adriaan C A D
• Plaisier, Loes
• Seelen, Marc A J
• Sanders, Jan-Stephan F
• Hepkema, Bouke G
• Lambeck, Annechien J
• Bungener, Laura B
• Roozendaal, Caroline
• Tilanus, Marcel G J
• Voorter, Christien E
• Wieten, Lotte
• van Duijnhoven, Elizabeth M
• Gelens, Mariëlle A C J
• Christiaans, Maarten H L
• van Ittersum, Frans J
• Nurmohamed, Shaikh A
• Lardy, Neubury M
• Swelsen, Wendy
• van der Pant, Karlijn A
• van der Weerd, Neelke C
• Ten Berge, Ineke J M
• Bemelman, Frederike J
• Hoitsma, Andries
• van der Boog, Paul J M
• de Fijter, Johan W
• Betjes, Michiel G H
• Heidt, Sebastiaan
• Roelen, Dave L
• Claas, Frans H
• Otten, Henderikus G
• Hilbrands, Luuk B

Titel

Effect of initial immunosuppression on long-term kidney transplant outcome in immunological low-risk patients

Ist Teil von

• Nephrology, dialysis, transplantation, 2019-08, Vol.34 (8), p.1417-1422

Ort / Verlag

England

Erscheinungsjahr

2019

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• 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. 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. 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). 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.