Comparison of Efficacy and Renal Function in KidneyTransplant Recipients Receiving Tacrolimus (TAC)-Based Immunosuppressive Regimens in Combination With Everolimus (EVR) or Mycophenolate (MPA)
1Nephrology, Hospital do Rim UNIFESP, Sao Paulo, Brazil
2Pathology, UNIFESP, Sao Paulo, Brazil.
Meeting: 2015 American Transplant Congress
Abstract number: D121
Keywords: Efficacy, Immunosuppression, Kidney transplantation, Renal function
Session Information
Session Name: Poster Session D: Kidney Immunosuppression: Drug Minimization
Session Type: Poster Session
Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Introduction: Acute rejection and renal function are associated with long-term renal allograft survival. We evaluated these outcomes in patients receiving reduced TAC exposure combined with EVR or standard TAC combined with MPA.Methods: In this single center prospective study, 288 low immunological risk kidney transplant recipients were randomized to receive (1) a single 3 mg/kg dose of antithymocyte globulin, reduced TAC (<5 ng/ml), EVR (4-8 ng/mL) and prednisone (PRED) (G1, n=85); (2) basiliximab, reduced TAC (6 ng/ml for 3 months and <5 ng/mL 4-12 months), EVR (4-8 ng/mL) and PRED (G2, n=102); (3) basiliximab, TAC (6-8 ng/ml), MPA (1440 mg/day) and PRED (G3, N=101). Anti-HLA donor specific antibodies (DSA) along with a protocol biopsy were investigated at 12 months. Soluble CD30 (sCD30) was also done at months 3. This analysis evaluated renal function during 12 months based on estimated glomerular filtration rate (eGFR) by MDRD, using the last observation carried forward (LOCF) method.
Results: The mean age was 45 years and 52% Caucasian. 69% were recipients of deceased donor kidney allografts showing no differences in mean kidney donor profile index (KDPI, 45%±22% vs. 52%±24% vs. 49%±24%) and in mean kidney donor risk index (KDRI, 0.9±0.2 vs. 1.0±0.2 vs. 1.0±0.2), respectively. Final donor creatinine was higher in G1 (2.2±2.2 vs 1.6±1.1 vs 1.6±1.3 mg/dL, p=0.024). Plasma sCD30 concentration >34.15 ng/mL was associated with inferior renal function at 12 months (1.34±0.41 vs. 1.51±0.67 mg/dL, p=0.012).
| Table 1 | G1 | G2 | G3 |
| Incidence of delayed graft function (DGF), % | 47 | 49 | 42 |
| Duration of DGF, days | 11±5 | 15±14 | 10 ± 6 |
| eGFR, LOCF analysis, ml/min | 63±25 | 58±23 | 63±29 |
| Urinary protein, g/L | 0.4±0.7 | 0.4±0.8 | 0.2±0.4 |
The incidence of first treated biopsy confirmed acute rejection was higher in G2 (tBCAR, 9% vs. 19% vs. 16%, p= 0.403). The proportion of patients with DSA was 7%, 6% and 7%, and the incidence of IF/TA in protocol biopsies was 35%, 32% and 23%, respectively.
Conclusion: Although no statistical differences were observed, patients in G2 showed higher incidence of tBCAR and lower renal function compared to MPA. There was no difference in the incidence of DSA among the 3 groups.
To cite this abstract in AMA style:
Ferreira A, Felipe C, Ueno P, Hannun P, Ruppel P, Sandes-Freitas T, Proença H, Pestana JMedina-, Tedesco-Silva H. Comparison of Efficacy and Renal Function in KidneyTransplant Recipients Receiving Tacrolimus (TAC)-Based Immunosuppressive Regimens in Combination With Everolimus (EVR) or Mycophenolate (MPA) [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/comparison-of-efficacy-and-renal-function-in-kidneytransplant-recipients-receiving-tacrolimus-tac-based-immunosuppressive-regimens-in-combination-with-everolimus-evr-or-mycophenolate-mpa/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress