1. Minimization of maintenance immunosuppressive therapy after renal transplantation comparing cyclosporine A/azathioprine or cyclosporine A/mycophenolate mofetil bitherapy to cyclosporine A monotherapy: a 10-year postrandomization follow-up study.
- Author
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Thierry A, Le Meur Y, Ecotière L, Abou-Ayache R, Etienne I, Laurent C, Vuiblet V, Colosio C, Bouvier N, Aldigier JC, Rerolle JP, Javaugue V, Gand E, Bridoux F, Essig M, Hurault de Ligny B, and Touchard G
- Subjects
- Adult, Azathioprine adverse effects, Cyclosporins adverse effects, Drug Therapy, Combination, Female, Follow-Up Studies, Graft Rejection, Graft Survival, Humans, Immunosuppression Therapy methods, Immunosuppressive Agents adverse effects, Kidney Transplantation adverse effects, Kidney Transplantation methods, Male, Middle Aged, Mycophenolic Acid administration & dosage, Mycophenolic Acid adverse effects, Prospective Studies, Risk Assessment, Statistics, Nonparametric, Survival Analysis, Time Factors, Treatment Outcome, Azathioprine administration & dosage, Cyclosporins administration & dosage, Immunosuppressive Agents administration & dosage, Kidney Transplantation mortality, Maintenance Chemotherapy methods, Mycophenolic Acid analogs & derivatives
- Abstract
Long-term outcomes in renal transplant recipients withdrawn from steroid and submitted to further minimization of immunosuppressive regimen after 1 year are lacking. In this multicenter study, 204 low immunological risk kidney transplant recipients were randomized 14.2 ± 3.7 months post-transplantation to receive either cyclosporine A (CsA) + azathioprine (AZA; n = 53), CsA + mycophenolate mofetil (MMF; n = 53), or CsA monotherapy (n = 98). At 3 years postrandomization, the occurrence of biopsy for graft dysfunction was similar in bitherapy and monotherapy groups (21/106 vs. 26/98; P = 0.25). At 10 years postrandomization, patients' survival was 100%, 94.2%, and 95.8% (P = 0.25), and death-censored graft survival was 94.9%, 94.7%, and 95.2% (P = 0.34) in AZA, MMF, and CsA groups, respectively. Mean estimated glomerular filtration rate was 70.4 ± 31.1, 60.1 ± 22.2, and 60.1 ± 19.0 ml/min/1.73 m(2), respectively (P = 0.16). The incidence of biopsy-proven acute rejection was 1.4%/year in the whole cohort. None of the patients developed polyomavirus-associated nephropathy. The main cause of graft loss (n = 12) was chronic antibody-mediated rejection (n = 6). De novo donor-specific antibodies were detected in 13% of AZA-, 21% of MMF-, and 14% of CsA-treated patients (P = 0.29). CsA monotherapy after 1 year is safe and associated with prolonged graft survival in well-selected renal transplant recipient (ClinicalTrials.gov number: 980654)., (© 2015 Steunstichting ESOT.)
- Published
- 2016
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