Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2016; 6(4): 697-702
Published online Dec 24, 2016. doi: 10.5500/wjt.v6.i4.697
Tacrolimus confers lower acute rejection rates and better renal allograft survival compared to cyclosporine
Mahmoud Kamel, Manish Kadian, Titte Srinivas, David Taber, Maria Aurora Posadas Salas
Mahmoud Kamel, Manish Kadian, Titte Srinivas, Maria Aurora Posadas Salas, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
David Taber, Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, United States
Author contributions: Kamel M contributed to data collection, manuscript writing, and manuscript revision; Kadian M contributed to data collection and manuscript writing; Srinivas T contributed to study design and manuscript revision; Taber D contributed to study design, data analysis, and manuscript revision; Posadas Salas MA contributed to study design, data collection, manuscript writing, and manuscript revision.
Institutional review board statement: This study was reviewed and approved by the Medical University of South Carolina Institutional Review Board (IRB).
Informed consent statement: Retrospective analysis was performed on deidentified clinical data. After review, the IRB waived the requirements for individual informed consent because the study was considered minimal risk and strict safeguards are in place to ensure confidentiality of those included in the analysis.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maria Aurora Posadas Salas, MD, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC 29425, United States. posadas@musc.edu
Telephone: +1-843-7922123 Fax: +1-843-7928399
Received: April 28, 2016
Peer-review started: April 28, 2016
First decision: July 5, 2016
Revised: September 1, 2016
Accepted: September 21, 2016
Article in press: September 23, 2016
Published online: December 24, 2016
Processing time: 229 Days and 22.8 Hours
Abstract
AIM

To compare the impact of tacrolimus (FK) and cyclosporine (CYA) on acute rejection and graft survival and to assess the predominant causes of graft loss between patients receiving these two calcineurin inhibitors (CNIs).

METHODS

Retrospective review of 1835 patients who received a kidney transplant (KTX) between 1999-2012. Patients were grouped based on initial CNI utilized: 1195 in FK group, 640 in CYA group. Data on baseline characteristics, clinical outcomes, and causes of graft loss in both groups were analyzed.

RESULTS

Cumulative acute rejection rates were 14% in the FK vs 24% in the CYA group. Despite more marginal donor characteristics in the FK group, these patients had better graft survival rates compared to the CYA group. Three and five year graft survival rates were 88% and 84% respectively in the FK group compared to 79% and 70% respectively in the CYA group (P < 0.001). After multivariate analysis, which controlled for confounders, FK use was a strong predictor for lower acute rejection rates [odds ratio (OR) 0.60, 95%CI: 0.45-0.79] and better renal allograft survival (OR 0.740, 95%CI: 0.58-0.94). Death with a functioning graft was the most common cause of graft loss in both groups. Common causes of death included cardiovascular disease, infections, and malignancies. Chronic allograft nephropathy was also found to be an important cause of graft loss, being more prevalent in the CYA group.

CONCLUSION

The use of FK-based maintenance immunosuppression therapy is associated with a significantly lower rate of acute rejection and better graft survival compared to CYA-based regimen. Individualizing immunosuppression through risk-stratified CNI choice may lead to improved outcomes across all spectra of KTX patients.

Keywords: Tacrolimus; Cyclosporine; Renal allograft survival

Core tip: Tacrolimus (FK) has surpassed cyclosporine (CYA) as the calcineurin inhibitor (CNI) of choice for the vast majority of kidney transplant (KTX) programs. Yet, CYA continues to be an important alternative for patients intolerant to FK. FK is associated with significantly lower rate of acute rejection and better graft survival compared to CYA. Individualizing immunosuppression through risk-stratified CNI choice may lead to improved outcomes across all spectra of KTX patients.