A comparison of major immunosuppressive triple therapies in renal transplantation

1. Triple therapies with NMS and FMS are currently most common maintenance immunosuppressive protocols. More than 80% of all triple therapy patients are on NMS and FMS. 2. There was no significant difference between N-based and F-based triple therapy protocols in combination with either AS or MS or RS adjunctive agents. 3. In living donor transplants, especially for Caucasian patients, N-based triple therapies have relative higher graft survival rates compared to F-based triple therapies, even though the difference is not statistically significant. 4. In cadaver donor transplants, patients on FAS and FMS have relative higher 5-year graft survival rates compared to patients on NAS and NMS. Neoral seemed to be better than tacrolimus when RS was used as its adjunctive agent. 5. Five-year graft survival rates of NMS and FMS are almost the same when recipients are younger than age 60. For older Caucasian recipients (> or = 60), patients on NMS have relatively higher 5-year graft survival rates than those on FMS. The difference is more obvious for patients with living donor kidney transplants. For older black patients, FMS has a relatively higher graft survival rate and the difference is more obvious for those with cadaver donor transplants. 6. Neoral is safer than tacrolimus when patients have insufficient kidney function after transplantation. 7. In most cases, patients on immunosuppressive protocols with MMF as an adjunctive agent have higher graft survival rates compared to azathioprine. 8. The definitive role of rapamycin is yet to be determined because a significant amount of information on rapamycin is not available; however, since it has no nephrotoxicity, it may become a good candidate for those patients who suffer from acute or chronic nephrotoxicity of calcineurin inhibitors.