Steroid Sparing with Tacrolimus and Mycophenolate Mofetil in Renal Transplantation

Abstract

Evidence suggests that steroid sparing in renal transplantation is associated with good outcomes, although there are limited data regarding steroid sparing in Tacrolimus and Mycophenolate Mofetil (MMF)-based regimes. In this study we describe the use of these agents in 101 consecutive patients undergoing renal transplantation using only a 7-day course of prednisolone.Median follow-up was 33 months (range 18-44). Patient and graft survival at 1 year were 100% and 98%, respectively. The acute rejection rate at both 6 and 12 months was 19%, with two episodes beyond 12 months. Anti-CD25 monoclonal antibody (anti-CD25 mAb) was administered to 25 patients at high immunological risk: a trend toward a lower rejection rate was seen in these patients compared with those at lower risk but not receiving induction therapy (8% vs. 22%; p = 0.11). Two patients experienced recurrent rejection. Of the twenty-three rejection episodes in total, 26% showed vascular involvement. Allograft function was preserved at 12 months with a mean creatinine of 144 lmol/L and mean estimated glomerular filtration rate (GFR) of 55 mL/min. At 12 months, the incidence of post-transplant diabetes mellitus was 3.5%.This steroid-sparing regime is associated with excellent patient and graft outcomes, and a low incidence of side effects.

Effect of Prednisone versus No Prednisone as Part of Maintenance Immunosuppression on Long-Term Renal Transplant Function

“…Birkeland (24) and Khwaja et al (30) reported excellent longterm graft survival and function (3 and 4 yr, respectively) with very low rejection rates. In other studies, a slight increase in acute rejection episodes, especially in the early posttransplantation period, was observed; these were easily reversible, and their impact on long-term graft survival is unclear at this time (27,(31)(32)(33)(34). In this context, we recently published a retrospective analysis from our transplant center of an examination of the impact of two different induction agents, alemtuzumab (Campath 1H, Berlex Laboratories, Wayne, NJ) versus basiliximab (Simulect, Novartis Pharmaceuticals, East Hanover, NJ) on long-term patient and graft survival for patients who were maintained on prednisone-free immunosuppression with tacrolimus and MMF (35).…”

Clinical Pharmacokinetics of Triple Immunosuppression Scheme in Kidney Transplant (Tacrolimus, Mycophenolate Mofetil and Corticosteroids)

“…Birkeland and Khwaja reported excellent long term graft survival and function (3 and 4 year, respectively) with very low rejection rates. In other studies, a slight increase in acute rejection episodes, especially in the early posttransplantation period, was observed; these were easily reversible, and their impact on long-term graft survival is unclear at this time (Borrows et al, 2004;Cole et al, 2001;Grewal et al, 1998;ter Meulen et al, 2004). Steroids, once thought to be a mandatory component of immunosuppression to preserve graft survival, are gradually being eliminated from current protocols.…”

Modern renal transplantation: present challenges and future prospects

“…It has been demonstrated that such approaches have reduced cardiovascular mortality without compromising graft survival,34 although there is a higher reported incidence of acute rejection in some patient groups such as African Americans.…”