Purpose: In 2005, an internal retrospective study at our institution showed a higher incidence of post transplant diabetes mellitus (PTDM) in our Hispanic kidney transplant recipients on tacrolimus (TAC)/prednisone regimen. Around this same time, we implemented a steroid avoidance program and changed our maintenance immunosuppression to a cyclosporine (CSA) based regimen in a subset of our Hispanic recipients. The objective of this study was to compare the renal function, acute rejection, graft and patient survival at 1, 3, and 5 years post transplant in Hispanic kidney transplant recipients who received CSA versus TAC. Additionally, we assessed the incidence of PTDM, CMV viremia, and BK viremia in this population.

Methods: This was a retrospective review of electronic medical records of all adult Hispanic patients that received a renal transplant from January 2004 to December 2009.

Results: We identified 169 Hispanic kidney transplant recipients for our cohort of which 80 were in the TAC group and 61 were in the CSA group. The remaining 28 patients were on an mTOR inhibitor and were not included in this analysis. More TAC patients received anti-thymocyte globulin and more CSA patients received basiliximab/daclizumab. Greater than 90% of patients were on a steroid avoidance calcineurin/mycophenolic acid regimen. The glomerular filtration rate and graft and patient survival at 1, 3, and 5 years post transplant were similar between the 2 groups. The incidence of acute rejection was 10.14% in the TAC group compared to 5.08% in the CSA group in the first-year post transplant (p=0.288). The incidence of PTDM in the first year was 15.4% in the TAC group and 13% in the CSA group. The incidence of BKV was 34.2% in the TAC group and 25.4% in the CSA group. The incidence of CMV viremia was 26.03% in the TAC group and 7.14% in the CSA group (p=0.005).

Conclusion: There was no difference in renal function, acute rejection rates, and patient and graft survival in our Hispanic kidney recipients on a TAC based regimen compared to a CSA based regimen. There was also no difference in the incidence of PTDM or BKV between the 2 groups. However, there was a significant increase in the incidence of CMV viremia in the TAC group and the incidence of BK viremia in both groups was higher than expected. Additional studies on the best immunosuppressive regimen for Hispanic patients are warranted as this population may benefit from a more personalized approach.

CITATION INFORMATION: West-Thielke P, Lasky A, Thielke J, Campara M, Benedetti E. Outcomes of Hispanic Kidney Transplant Recipients Under a Cyclosporine versus Tacrolimus Based Immunosuppression Protocol. Am J Transplant. 2016;16 (suppl 3).

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