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Conversion from tacrolimus‐mycophenolate mofetil to tacrolimus‐ mTOR immunosuppression after kidney‐pancreas transplantation reduces the incidence of both BK and CMV viremia
Author(s) -
Knight Richard J.,
Graviss Edward A.,
Nguyen Duc T.,
Kuten Samantha A.,
Patel Samir J.,
Gaber Lillian,
Gaber A. Osama
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13265
Subject(s) - immunosuppression , medicine , tacrolimus , hazard ratio , transplantation , kidney transplantation , calcineurin , bk virus , mycophenolic acid , sirolimus , gastroenterology , immunology , confidence interval
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.