Conversion from tacrolimus‐mycophenolate mofetil to tacrolimus‐mTOR immunosuppression after kidney‐pancreas transplantation reduces the incidence of both BK and CMV viremia

Abstract

We sought to determine whether conversion from tacrolimus/mycophenolate mofetil (TAC-MMF) into tacrolimus/mTOR inhibitor (TAC-mTOR) immunosuppression would reduce the incidences of BK and CMV viremia after kidney/pancreas (KP) transplantation. In this single-center review, the TAC-mTOR cohort (n=39) was converted at 1month post-transplant to an mTOR inhibitor and reduced-dose tacrolimus. Outcomes were compared to a cohort of KP recipients (n=40) maintained on TAC-MMF. At 3years post-transplant, KP survivals and incidences of kidney/pancreas rejection were equivalent between mTOR and MMF-treated cohorts. (P=ns). BK viremia-free survival was better for the mTOR vs MMF-treated group (P=.004). In multivariate analysis, MMF vs mTOR immunosuppression was an independent risk factor for BK viremia (hazard ratio 12.27, P=.02). Similarly, mTOR-treated recipients displayed better CMV infection-free survival compared to the MMF-treated cohort (P=.01). MMF vs mTOR immunosuppression (hazard ratio 18.77, P=.001) and older recipient age (hazard ratio 1.13 per year, P=.006) were independent risk factors for CMV viremia. Mean estimated GFR and HgbA1c levels were equivalent between groups at 1, 2, and 3years post-transplantation. Conversion from TAC/MMF into TAC/mTOR immunosuppression after KP transplantation reduced the incidences of BK and CMV viremia with an equivalent risk of acute rejection and similar renal/pancreas function.