Sirolimus in combination with low-dose extended-release tacrolimus in kidney transplant recipients
Many challenges remain for long-term survival of renal allografts. Once-daily sirolimus (SRL) combined with low-dose extended-release tacrolimus (LER-TAC) may improve medication adherence and reduce the potential nephrotoxicity of calcineurin inhibitors (CNI) compared with standard immunosuppression...
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| Published in | Frontiers in medicine Vol. 10; p. 1281939 |
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| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
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| Abstract | Many challenges remain for long-term survival of renal allografts. Once-daily sirolimus (SRL) combined with low-dose extended-release tacrolimus (LER-TAC) may improve medication adherence and reduce the potential nephrotoxicity of calcineurin inhibitors (CNI) compared with standard immunosuppression regimens, thus potentially improving long-term graft survival.
This retrospective, observational, single-center, propensity score matching (PSM) study compared conversion to SRL combined with low-dose ER-TAC and mycophenolic acid (MPA) combined with standard-dose TAC in kidney transplant recipients. After PSM, there were 56 patients in each group. Efficacy, safety, and medication adherence were evaluated over 12 months.
There was no significant difference between the two groups in terms of graft and recipient survival and incidence of biopsy-proven acute rejection (
= 1.000), and none of the recipients developed dnDSA after conversion. The mean eGFR improved in SRL + LER-TAC group after conversion compared to before conversion (51.12 ± 20.1 ml/min/1.73 m
vs. 56.97 ± 19.23 ml/min/1.73 m
,
< 0.05). The medication adherence at 12 months after conversion was superior to before conversion (
= 0.002).
Our findings suggest that an immunosuppressive regimen of SRL combined with low-dose ER-TAC is no less effective and safe than standard immunosuppressive regimens for renal transplant recipients and may improve graft renal function and medication adherence. |
|---|---|
| AbstractList | IntroductionMany challenges remain for long-term survival of renal allografts. Once-daily sirolimus (SRL) combined with low-dose extended-release tacrolimus (LER-TAC) may improve medication adherence and reduce the potential nephrotoxicity of calcineurin inhibitors (CNI) compared with standard immunosuppression regimens, thus potentially improving long-term graft survival.MethodsThis retrospective, observational, single-center, propensity score matching (PSM) study compared conversion to SRL combined with low-dose ER-TAC and mycophenolic acid (MPA) combined with standard-dose TAC in kidney transplant recipients. After PSM, there were 56 patients in each group. Efficacy, safety, and medication adherence were evaluated over 12 months.ResultsThere was no significant difference between the two groups in terms of graft and recipient survival and incidence of biopsy-proven acute rejection (p = 1.000), and none of the recipients developed dnDSA after conversion. The mean eGFR improved in SRL + LER-TAC group after conversion compared to before conversion (51.12 ± 20.1 ml/min/1.73 m2 vs. 56.97 ± 19.23 ml/min/1.73 m2, p < 0.05). The medication adherence at 12 months after conversion was superior to before conversion (p = 0.002).DiscussionOur findings suggest that an immunosuppressive regimen of SRL combined with low-dose ER-TAC is no less effective and safe than standard immunosuppressive regimens for renal transplant recipients and may improve graft renal function and medication adherence. Many challenges remain for long-term survival of renal allografts. Once-daily sirolimus (SRL) combined with low-dose extended-release tacrolimus (LER-TAC) may improve medication adherence and reduce the potential nephrotoxicity of calcineurin inhibitors (CNI) compared with standard immunosuppression regimens, thus potentially improving long-term graft survival.IntroductionMany challenges remain for long-term survival of renal allografts. Once-daily sirolimus (SRL) combined with low-dose extended-release tacrolimus (LER-TAC) may improve medication adherence and reduce the potential nephrotoxicity of calcineurin inhibitors (CNI) compared with standard immunosuppression regimens, thus potentially improving long-term graft survival.This retrospective, observational, single-center, propensity score matching (PSM) study compared conversion to SRL combined with low-dose ER-TAC and mycophenolic acid (MPA) combined with standard-dose TAC in kidney transplant recipients. After PSM, there were 56 patients in each group. Efficacy, safety, and medication adherence were evaluated over 12 months.MethodsThis retrospective, observational, single-center, propensity score matching (PSM) study compared conversion to SRL combined with low-dose ER-TAC and mycophenolic acid (MPA) combined with standard-dose TAC in kidney transplant recipients. After PSM, there were 56 patients in each group. Efficacy, safety, and medication adherence were evaluated over 12 months.There was no significant difference between the two groups in terms of graft and recipient survival and incidence of biopsy-proven acute rejection (p = 1.000), and none of the recipients developed dnDSA after conversion. The mean eGFR improved in SRL + LER-TAC group after conversion compared to before conversion (51.12 ± 20.1 ml/min/1.73 m2 vs. 56.97 ± 19.23 ml/min/1.73 m2, p < 0.05). The medication adherence at 12 months after conversion was superior to before conversion (p = 0.002).ResultsThere was no significant difference between the two groups in terms of graft and recipient survival and incidence of biopsy-proven acute rejection (p = 1.000), and none of the recipients developed dnDSA after conversion. The mean eGFR improved in SRL + LER-TAC group after conversion compared to before conversion (51.12 ± 20.1 ml/min/1.73 m2 vs. 56.97 ± 19.23 ml/min/1.73 m2, p < 0.05). The medication adherence at 12 months after conversion was superior to before conversion (p = 0.002).Our findings suggest that an immunosuppressive regimen of SRL combined with low-dose ER-TAC is no less effective and safe than standard immunosuppressive regimens for renal transplant recipients and may improve graft renal function and medication adherence.DiscussionOur findings suggest that an immunosuppressive regimen of SRL combined with low-dose ER-TAC is no less effective and safe than standard immunosuppressive regimens for renal transplant recipients and may improve graft renal function and medication adherence. Many challenges remain for long-term survival of renal allografts. Once-daily sirolimus (SRL) combined with low-dose extended-release tacrolimus (LER-TAC) may improve medication adherence and reduce the potential nephrotoxicity of calcineurin inhibitors (CNI) compared with standard immunosuppression regimens, thus potentially improving long-term graft survival. This retrospective, observational, single-center, propensity score matching (PSM) study compared conversion to SRL combined with low-dose ER-TAC and mycophenolic acid (MPA) combined with standard-dose TAC in kidney transplant recipients. After PSM, there were 56 patients in each group. Efficacy, safety, and medication adherence were evaluated over 12 months. There was no significant difference between the two groups in terms of graft and recipient survival and incidence of biopsy-proven acute rejection ( = 1.000), and none of the recipients developed dnDSA after conversion. The mean eGFR improved in SRL + LER-TAC group after conversion compared to before conversion (51.12 ± 20.1 ml/min/1.73 m vs. 56.97 ± 19.23 ml/min/1.73 m , < 0.05). The medication adherence at 12 months after conversion was superior to before conversion ( = 0.002). Our findings suggest that an immunosuppressive regimen of SRL combined with low-dose ER-TAC is no less effective and safe than standard immunosuppressive regimens for renal transplant recipients and may improve graft renal function and medication adherence. |
| Author | Dai, Lin-rui Shi, Hui-bo Chen, Zhi-shui Chen, Yan-yan Zhang, Wei-jie Hou, Yi-bo Gong, Nian-qiao Chang, Sheng Liu, Bin Chen, Ren-jie Zou, Zhi-yu Yu, Chen-zhen Chen, Song |
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| Cites_doi | 10.1016/S0149-2918(01)80109-0 10.1111/ajt.14090 10.1007/s10157-019-01822-6 10.1111/ajt.15081 10.1097/tp.0000000000001777 10.1681/asn.2018010009 10.1097/TP.0b013e318211d342 10.1111/ctr.13463 10.1111/j.1600-6143.2011.03686.x 10.1097/tp.0000000000001651 10.1111/ajt.13327 10.3390/ijms23147707 10.1111/ctr.13464 10.1016/j.kint.2019.01.041 10.1111/ajt.14215 10.1016/j.trre.2013.06.001 10.18632/aging.202863 10.1016/j.asjsur.2019.07.011 10.1097/tp.0000000000001589 10.1097/tp.0000000000002626 10.1111/j.1600-6143.2005.01019.x 10.1111/ajt.15480 10.1016/j.trre.2014.03.002 10.1111/ajt.15672 10.1016/j.transproceed.2015.12.077 10.1111/j.1399-0012.2007.00756.x 10.1111/ajt.12166 10.1097/tp.0000000000001520 10.1111/j.1600-6143.2005.01193.x 10.1056/NEJMoa067411 10.1111/ajt.16502 10.1111/j.1600-6143.2010.03256.x 10.1111/j.1600-6143.2006.01340.x 10.1093/ndt/gfx093 10.1002/14651858.CD004290.pub3 10.1111/ajt.16982 10.1097/TP.0b013e3181927a41 |
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| Keywords | immunosuppressant medication adherence tacrolimus kidney transplantation sirolimus |
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| Title | Sirolimus in combination with low-dose extended-release tacrolimus in kidney transplant recipients |
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