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Published on: November 8, 2015
Sirolimus Associated with Tacrolimus at Low Doses in Elderly Kidney Transplant Patients: A Prospective Randomized
Cristiane Akemi Kojima1, Hong Si Nga, Henrique Mochida Takase
1Department of Internal Medicine, Univ Estadual Paulista, Botucatu, Brazil.
Objectives:
There is no consensus on the best immunosuppressive regimen for elderly renal transplant recipients. The objective of this study was to assess cytomegalovirus infection incidence and kidney transplant outcomes in elderly recipients treated with mammalian target of rapamycin inhibitors sirolimus/ tacrolimus at low doses compared with those receiving tacrolimus/mycophenolate sodium.
Materials And Methods:
In this single-center prospective randomized study (Trial Registration No. NCT02683291), kidney transplant recipients over 60 years of age were randomly allocated into 2 groups: tacrolimus-sirolimus (21 patients) and tacrolimus-mycophenolate (23 patients). Cytomegalovirus infection rate and patient survival, biopsy-proven acute rejection, and renal function at 12 months were assessed.
Results:
Cytomegalovirus infection rate was higher in the mycophenolate group (60.9%) than in the sirolimus group (16.7%; P = .004). The rates of biopsy-proven acute rejection, patient survival, graft survival, and estimated glomerular filtration rate over 12 months did not significantly differ between groups.
Conclusions:
The incidence of cytomegalovirus infection was significantly lower in the sirolimus group. The use of tacrolimus combined with sirolimus in elderly kidney transplant recipients is safe.
Insights
Elderly kidney transplant patients on sirolimus had lower cytomegalovirus infection rates. Tacrolimus and sirolimus combination therapy is safe for these patients, showing comparable transplant outcomes.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation
Background:
- Optimal immunosuppression for elderly kidney transplant recipients remains unclear.
- Cytomegalovirus (CMV) infection is a significant concern in transplant patients.
Purpose of the Study:
- To compare CMV infection incidence and kidney transplant outcomes.
- To evaluate low-dose sirolimus/tacrolimus versus tacrolimus/mycophenolate sodium in elderly recipients.
Main Methods:
- Single-center prospective randomized study.
- Elderly kidney transplant recipients (>60 years) randomized into two groups: tacrolimus-sirolimus (21) and tacrolimus-mycophenolate (23).
- Assessed CMV infection, patient survival, acute rejection, and renal function at 12 months.
Main Results:
- CMV infection rate was significantly lower in the sirolimus group (16.7%) compared to the mycophenolate group (60.9%).
- No significant differences were observed in biopsy-proven acute rejection, patient survival, graft survival, or estimated glomerular filtration rate between the groups at 12 months.
Conclusions:
- Sirolimus-based immunosuppression significantly reduces CMV infection incidence in elderly kidney transplant recipients.
- Tacrolimus combined with sirolimus is a safe and effective immunosuppressive strategy for this population.
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