Effect of initial immunosuppression on long-term kidney transplant outcome in immunological low-risk patients
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.
(2019) Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, volume 34, issue 8, pp. 1417 - 1422
(Article)
Abstract
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.
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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.
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Keywords: anti-HLA antibodies, graft survival, immunological low-risk, immunosuppression, kidney transplantation, Nephrology, Transplantation, Journal Article, Taverne
ISSN: 0931-0509
Publisher: Oxford University Press
Note: Publisher Copyright: © 2018 The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
(Peer reviewed)
