5 Scopus citations

Abstract

Background: We sought to determine whether conversion from tacrolimus/mycophenolate mofetil (TAC-MMF) into tacrolimus/mTOR inhibitor (TAC-mTOR) immunosuppression would reduce the incidences of BK and CMV viremia after kidney/pancreas (KP) transplantation. Methods: In this single-center review, the TAC-mTOR cohort (n = 39) was converted at 1 month post-transplant to an mTOR inhibitor and reduced-dose tacrolimus. Outcomes were compared to a cohort of KP recipients (n = 40) maintained on TAC-MMF. Results: At 3 years post-transplant, KP survivals and incidences of kidney/pancreas rejection were equivalent between mTOR and MMF-treated cohorts. (P = ns). BK viremia-free survival was better for the mTOR vs MMF-treated group (P = .004). In multivariate analysis, MMF vs mTOR immunosuppression was an independent risk factor for BK viremia (hazard ratio 12.27, P = .02). Similarly, mTOR-treated recipients displayed better CMV infection-free survival compared to the MMF-treated cohort (P = .01). MMF vs mTOR immunosuppression (hazard ratio 18.77, P = .001) and older recipient age (hazard ratio 1.13 per year, P = .006) were independent risk factors for CMV viremia. Mean estimated GFR and HgbA1c levels were equivalent between groups at 1, 2, and 3 years post-transplantation. Conclusion: Conversion from TAC/MMF into TAC/mTOR immunosuppression after KP transplantation reduced the incidences of BK and CMV viremia with an equivalent risk of acute rejection and similar renal/pancreas function.

Original languageEnglish (US)
Article numbere13265
Pages (from-to)e13265
JournalClinical Transplantation
Volume32
Issue number6
Early online dateApr 19 2018
DOIs
StatePublished - Jun 2018

Keywords

  • Graft survival
  • Immunosuppression
  • Incidence
  • Kidney
  • Mycophenolic acid
  • Pancreas transplantation
  • Risk factors
  • Tacrolimus
  • Viremia
  • risk factors
  • tacrolimus
  • mycophenolic acid
  • graft survival
  • immunosuppression
  • pancreas transplantation
  • kidney
  • incidence
  • viremia

ASJC Scopus subject areas

  • Transplantation

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