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A comparison of discharge immunosuppressive drug regimens in primary cadaveric kidney transplantation. Transplantation 2003 Aug 15;76(3):463-70

Date

08/19/2003

Pubmed ID

12923430

DOI

10.1097/01.TP.0000079839.38844.09

Scopus ID

2-s2.0-0042467485   21 Citations

Abstract

BACKGROUND: Finding the best combination of immunosuppression is an important challenge in kidney transplantation. Current short-term (1- and 3-year) allograft survival is quite good, making it difficult to determine differences in therapeutic regimens without large sample sizes. Using data from the United Network for Organ Sharing/Organ Procurement and Transplantation Network database, the current study provides substantial statistical power to analyze the outcomes for different immunosuppressive regimens.

METHODS: To compare the effects of four discharge regimens (cyclosporine and azathioprine [CYA+AZA], CYA and mycophenolate mofetil [MMF], tacrolimus [TAC]+AZA, and TAC+MMF) on long-term survival, a multivariate Cox regression analysis was conducted on 19246 primary cadaveric kidney transplants during 1995 to 1998.

RESULTS: Compared with CYA+AZA, the combination of CYA+MMF was associated with a 10% reduced risk of graft loss (relative risk [RR] 0.90, 95% confidence limit [CL] 0.84-0.96, P<0.001), whereas TAC+AZA was associated with an 18% reduced risk (RR 0.82, 95% CL 0.67-1.005, P=0.06) and TAC+MMF with a 20% reduced risk of graft loss (RR 0.80, 95% CL 0.71-0.89, P<0.001). All three regimens benefited patients regardless of delayed graft function (DGF) or early acute rejection status. In addition, in the absence of DGF, the combinations of CYA+MMF, TAC+AZA, and TAC+MMF were associated with a reduced risk of mortality compared with CYA+AZA.

CONCLUSIONS: The major finding of this study was improved graft and patient survival associated with TAC+MMF and CYA+MMF in patients with or without DGF or early acute rejection.

Author List

Cherikh WS, Myron Kauffman H, Maghirang J, Bleyer AJ, Johnson CP

Author

Christopher P. Johnson MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Azathioprine
Cadaver
Cyclosporine
Drug Therapy, Combination
Female
Graft Rejection
Humans
Immunosuppressive Agents
Kidney Transplantation
Male
Mycophenolic Acid
Tacrolimus
Treatment Outcome
jenkins-FCD Prod-478 d1509cf07a111124a2d122fd3df854cc0b993c00