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Evolving strategies in immunosuppressive therapy: the Emory experience
J D Whelchel1, L C Hymes, E L Hochgelerent
1Emory University Renal Transplant Programs, Emory University, Atlanta, Georgia, USA.
Clinical Transplants
|January 1, 1996
Summary
Mycophenolate mofetil (MMF) combined with cyclosporine (CsA) and prednisone without induction therapy shows superior one-year graft survival in renal transplant patients. This immunosuppression strategy may improve long-term outcomes, especially for Black recipients.
Area of Science:
- Nephrology
- Immunosuppression Therapy
- Transplantation Medicine
Background:
- Review of 2,065 renal transplant recipients over 11 years.
- Comparison of various immunosuppression regimens including cyclosporine (CsA), imuran, prednisone, polyclonal (PCA), and monoclonal (MCA) antibody induction.
- Evaluation of a recent regimen using CsA, mycophenolate mofetil (MMF), and prednisone without induction.
Purpose of the Study:
- To evaluate the efficacy of different immunosuppression strategies on renal transplant graft survival.
- To compare graft survival rates between various induction therapies and maintenance regimens.
- To assess the potential of MMF-based immunosuppression for improving outcomes in diverse patient populations.
Main Methods:
- Retrospective analysis of 2,065 renal transplant recipients.
- Comparison of graft survival at 1 and 5 years post-transplantation.
- Analysis of outcomes based on induction therapy (none, PCA, MCA) and maintenance immunosuppression (CsA/imuran/prednisone vs. CsA/MMF/prednisone).
Main Results:
- Polyclonal antibody (PCA) induction showed better 5-year graft survival than MCA induction or no induction.
- Mycophenolate mofetil (MMF) resulted in superior one-year graft survival compared to PCA, MCA, or standard triple therapy.
- Similar one-year graft survival in Black and White recipients on MMF suggests potential for improved long-term outcomes in Black recipients.
Conclusions:
- An immunosuppressive protocol of MMF, CsA, and prednisone without induction achieves excellent short-term graft survival.
- MMF-based immunosuppression demonstrates equal or superior graft survival compared to previous induction therapy protocols.
- MMF-based immunosuppression may offer improved long-term graft survival, particularly for Black renal transplant recipients.
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