Purpose: In 2005, an internal retrospective review of kidney transplant recipients (KTx) showed a higher incidence of post transplant diabetes mellitus (PTDM) for Hispanic patients on tacrolimus (TAC) despite steroid avoidance. Consequently, a protocol change was implemented where low rejection risk, non-diabetic Hispanic patients preferentially received cyclosporine (CSA) based maintenance regimen. 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 KTx recipients who received CSA versus TAC. Additionally, we assessed the incidence of PTDM, CMV viremia, and BK viremia (BKV) in this population.

Methods: This was a retrospective review of electronic medical records of all adult Hispanic patients (age ≥18 years old at transplantation) that received a KTx from January 2004 to December 2009.

Results: Data was collected for 169 Hispanic KTx recipients, 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 (p=0.79). The incidence of BKV was 34.2% in the TAC group and 25.4% in the CSA group (p=0.24). 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 significant difference in renal function, acute rejection rates, and patient and graft survival in Hispanic KTx on a TAC based regimen compared to a CSA based regimen. No significant difference was noted in the incidence of PTDM or BKV between the 2 groups at 1 year. 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., Campara M., Tang I., Benedetti E. Outcomes of Hispanic Kidney Transplant Recipients under a Cyclosporine versus Tacrolimus Based Immunosuppression Protocol Am J Transplant. 2017;17 (suppl 3).

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