Best post-transplant drug regimen identified for patients with new kidneys

For the thousands of patients who receive kidney transplants in the United States each year, preventing organ rejection without compromising other aspects of health requires a delicate balance of medications. Immunosuppresive drugs that protect transplanted organs can also cause serious side effects, including compromising patients' immunity to infection, cancer, and other threats. Finding the best combination and dosage of drugs has often proved difficult for physicians.

A new multi-year study has now shown that using tacrolimus (TAC) and mycophenolate mofetil (MMF) in combination provided the best long-term benefits and the least amount of side effects after a . The results, which come from the longest randomized study to date that has analyzed transplant drugs, provide valuable guidance to physicians who care for for . The study, conducted by Giselle Guerra, MD, and colleagues at the University of Miami, appears in an upcoming issue of the Journal of the American Society Nephrology (JASN), a publication of the American Society of Nephrology.

To compare therapies, Dr. Guerra studied 150 kidney transplant recipients who received one of three common immunosuppressive treatment regimens: tacrolimus + MMF, tacrolimus + sirolimus, or + sirolimus. Tacrolimus and cyclosporine are in a class of drugs called calcineurin inhibitors; they can prevent early but can be toxic to the kidneys. Sirolimus and MMF do not damage the kidneys. Patients often receive low doses of calcineurin inhibitors plus sirolimus or MMF in order to gain the most benefit without serious risk to their kidneys. All patients in the study also received another called daclizumab shortly after transplantation, as well as steroids long term; they were followed for an average of eight years after transplantation.

Among the major findings:

  • Survival of transplanted organs was similar in all groups of patients.
  • Significantly fewer patients treated with tacrolimus + MMF (12%) experienced acute rejection, compared to those treated with tacrolimus + sirolimus (30%) or cyclosporine + sirolimus (28%).
  • Patients taking tacrolimus + MMF also had better kidney function during the first 36 months.
  • Patients taking tacrolimus + MMF or cyclosporine + sirolimus were less likely to die with a functioning transplant (12% and 4% respectively), compared to those treated with tacrolimus + sirolimus (26%).
  • Patients who took sirolimus were more likely to develop viral infections, discontinue treatment, and need cholesterol-lowering medications, compared to patients who were not taking sirolimus.

Taken together, these results suggest that transplant patients do better over the long term with tacrolimus + MMF than with either tacrolimus + sirolimus or cyclosporine + . "We have been able to prove that the use of low-dose and MMF is safe and provides excellent outcomes over time to renal transplant patients," said Dr. Guerra.

add to favorites email to friend print save as pdf

Related Stories

Switching immunosuppressants reduces cancer risk in kidney

Nov 02, 2009

Switching to a newer type of immunosuppressant drug may reduce the high rate of skin cancer after kidney transplantation, according to research being presented at the American Society of Nephrology's 42nd Annual Meeting and ...

Recommended for you

British Lords hold ten-hour debate on assisted dying

Jul 19, 2014

Members of Britain's unelected House of Lords spent almost ten hours on Friday discussing whether to legalise assisted dying, in an often emotional debate putting the question back on the agenda, if not on the statute books.

AbbVie, Shire agree on $55B combination

Jul 18, 2014

The drugmaker AbbVie has reached a deal worth roughly $55 billion to combine with British counterpart Shire and become the latest U.S. company to seek an overseas haven from tax rates back home.

Safety problems at US germ labs acknowledged

Jul 16, 2014

(AP)—The director of the U.S. Centers for Disease Control and Prevention acknowledged Wednesday that systemic safety problems have for years plagued federal public health laboratories that handle dangerous ...

User comments