In the US, MPA in combination with calcineurin inhibitors (CNI, tacrolimus [TAC] or cyclosporine A [CsA]) is the most commonly used maintenance immunosuppressive therapy post kidney transplant (KTx). We compared clinical outcomes post KTx of recipients who received EVR vs. MPA maintenance immunosuppression, using information from the United Network for Organ Sharing (UNOS) database.

Two mutually exclusive transplant periods were defined (Era 1: 1998-2007 and Era 2: 2010-2014; EVR was approved in the US in 2010). First time kidney only transplant recipients, ≥18 years, receiving EVR or MPA + CNI ± steroids at time of hospital discharge, between 01 January 1998 and 31 December 2014 were identified for inclusion in the analysis. KTx recipients were excluded if their allograft failed prior to discharge, they had received a donor organ with cold ischemia time >40 hours, or transplantation occurred in 2001 or 2008-2009 (when EVR was not used). Treatment selection bias was addressed using risk-adjusted methods. Cohorts were matched based on the propensity score for EVR using a greedy matching algorithm within donor type (living vs. deceased donor). Kaplan-Meier and stratified Cox hazard models were used to estimate and compare outcomes between cohorts.

Median follow-up was 5 years. Clinically well-matched cohorts were created. Long term outcomes were comparable for EVR vs. MPA-containing regimens with hazard ratios (95% confidence intervals) of 0.92 (0.80, 1.07) for all cause graft failure; 0.95 (0.78, 1.16) for death-censored graft loss and 0.98 (0.73, 1.31) for graft failure due to CAN. When CNI was restricted to TAC, treated acute rejection (AR) was comparable for both regimens (era 2) for deceased donor recipients (p=0.14); however a slightly higher rate of AR was noted for the EVR- vs. MPA- TAC-containing regimens for living donor recipients (p<0.05). The risk of treated AR was lower for EVR- vs. MPA- CsA-containing regimens for both living and deceased donors (era 2) (p<0.05). Graft survival (adjusted by era and TAC) was comparable at 5 years post-transplant for EVR vs. MPA.

In conclusion, long term outcomes for KTx recipients are similar for EVR- vs. MPA-treated patients, independent of donor status and CNI.

CITATION INFORMATION: Cibrik D, Irish W, McCague K, Patel D, Tedesco H. Comparison of Long Term Survival Outcomes for Everolimus (EVR) vs. Mycophenolic Acid (MPA) Immunosuppressive Regimens Post Kidney Transplant. Am J Transplant. 2017;17 (suppl 3).

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