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Outcomes of Patients on Reduced Immunosuppression After Renal Transplantation
*Asha Zimmerman, *Reginald Gohh, *George Bayliss, Reza Saidi, Paul Morrissey
Brown University, Providence, RI
Objective:To determine if decreasing immunosuppression is associated with worse patient and graft survival.
Design:Retrospective cohort.
Setting:University associated referral hospital.
Patients:Patients undergoing a renal transplant from 2005-2014 initiated on tacrolimus, mycophenolic acid and prednisone.
Interventions:None.
Main Outcome Measures:Patient and graft survival.
Results:We evaluated 351 patients including 35(10%) on two-agent immunosuppression (TA). Of these, 79% were maintained on tacrolimus/prednisone; the remainder were maintained on either mycophenolic acid/prednisone or tacrolimus/mycophenolic acid. The rationale for modifying therapy included infectious complications (74%), medication intolerance (51%) and malignancy (17%). Three hundred and sixteen patients in the same era were maintained on TMP. Mean follow-up was 63 months for TMP group and 60 months for TA group. There was no difference between TMP and TA groups in regards to age (49 vs 53, NS), sex (65% male vs 51% male, NS), incidence of diabetes (27% vs 23%, NS), proportion live donor recipient (43% vs 31%, NS), nadir creatinine (1.36 vs 1.30, NS), renal function (Cr 1.32 vs 1.33, NS) and rate of acute rejection (13% vs 11%, NS). There was no difference in patient survival or graft survival between the groups (Figure 1).
Conclusions:Changes in initial immunosuppression are frequent after renal transplantation; however, reduction in immunosuppression carries a risk of new complications or acute rejection. We demonstrated that reduction to a two-drug regimen based on clinical evidence of over-immunosuppression while on TMP was well tolerated and did not affect the rate of rejection, renal allograft function or intermediate-term graft survival.
Figure 1. Kaplan-Meier Curve for Patient/Graft Survival p=0.29/p=0.95
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