Conversion from tacrolimus-mycophenolate mofetil to tacrolimus-mTOR immunosuppression after kidney-pancreas transplantation reduces the incidence of both BK and CMV viremia

Richard J. Knight, Edward A. Graviss, Duc T. Nguyen, Samantha A. Kuten, Samir J. Patel, Lillian Gaber, A. Osama Gaber

Research output: Contribution to journalArticlepeer-review

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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