Effect of initial immunosuppression on long-term kidney transplant outcome in immunological low-risk patients
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Publication date
2019-08-01
Authors
Michielsen, Laura A
van Zuilen, Arjan D.
Verhaar, Marianne C.
Wisse, Bram W.
Kamburova, E. G.
Joosten, Irma
Allebes, Wil A.
van der Meer, Arnold
Baas, Marije C.
Spierings, Eric
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Article
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taverne
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. 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.
Keywords
anti-HLA antibodies, graft survival, immunological low-risk, immunosuppression, kidney transplantation, Taverne, Nephrology, Transplantation, Journal Article
Citation
Michielsen, L A, van Zuilen, A D, Verhaar, M C, Wisse, B W, Kamburova, E G, Joosten, I, Allebes, W A, van der Meer, A, Baas, M C, Spierings, E, Hack, C E, van Reekum, F E, Bots, M L, Drop, A C A D, Plaisier, L, Seelen, M A J, Sanders, J S F, Hepkema, B G, Lambeck, A J, Bungener, L B, Roozendaal, C, Tilanus, M G J, Voorter, C E, Wieten, L, van Duijnhoven, E M, Gelens, M A C J, Christiaans, M H L, van Ittersum, F J, Nurmohamed, S A, Lardy, N M, Swelsen, W, van der Pant, K A, van der Weerd, N C, Ten Berge, I J M, Bemelman, F J, Hoitsma, A, van der Boog, P J M, de Fijter, J W, Betjes, M G H, Heidt, S, Roelen, D L, Claas, F H, Otten, H G & Hilbrands, L B 2019, 'Effect of initial immunosuppression on long-term kidney transplant outcome in immunological low-risk patients', Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, vol. 34, no. 8, pp. 1417-1422. https://doi.org/10.1093/ndt/gfy377