Eight-year outcomes of 'the Cairo Kidney Centre sequential protocol'

Area of Science:

• Nephrology
• Immunology
• Transplantation Medicine

Background:

• Sequential immunosuppression protocols are crucial for kidney transplant success.
• Sirolimus-based regimens offer an alternative to calcineurin inhibitors.
• Long-term outcomes of sequential sirolimus protocols require further investigation.

Purpose of the Study:

• To evaluate the 8-year outcomes of a sequential immunosuppression protocol for kidney transplant.
• To compare patient survival, graft survival, and graft function between a sirolimus-based protocol and a standard cyclosporine-based protocol.

Main Methods:

• An 8-year follow-up study of kidney transplant recipients.
• Group A received a sirolimus + cyclosporine + prednisolone followed by sirolimus + prednisolone + mycophenolate mofetil.
• Group B received cyclosporine + mycophenolate mofetil + prednisolone.

Main Results:

• Intent-to-treat patient survival at 8 years was 85.5% for the sirolimus group (A) vs. 73% for the cyclosporine group (B).
• Death-censored graft survival was high in both groups (93% vs. 95%).
• Significantly better graft function (eGFR > 45 mL/min/1.73 m2) was observed in group A (91%) compared to group B (50%) at 8 years, with a lower incidence of chronic allograft nephropathy.

Conclusions:

• The sirolimus-based sequential protocol is well-tolerated and demonstrates equivalent patient and graft survival to standard protocols.
• This protocol leads to superior long-term graft function and reduced chronic allograft nephropathy.
• Adverse event profiles were similar between the groups.