Abstract
BackgroundThe actual prescription pattern of immunosuppressive agents in kidney transplantation is unclear.MethodsWe investigated the pattern and trend of immunosuppressive treatment for kidney transplant patients in South Korea. A total of 636 patients at nine transplant centers were enrolled and followed for one year. We reviewed medical records and evaluated induction therapy, as well as the changing pattern and cause of maintenance therapy.ResultsMost patients (n = 621, 97.6%) received induction therapy often comprising basiliximab (n = 542, 85.2%). The triple therapy including calcineurin inhibitor, mycophenolic acid, and steroids was the major initial maintenance immunosuppression (n = 518, 81.4%), but its proportion decreased by 14% (81.4% to 67.5%) after 1 year. Almost 40% of patients changed immunosuppressive regimen during the 1-year follow-up, most often at an early period (60.2% within the first 4 months). The primary reason for the change was gastrointestinal discomfort (n = 113, 29.8%), followed by infection (112, 29.6%). The most common changing pattern was mycophenolic acid withdrawal (n = 155, 39.1%).ConclusionThe initial immunosuppressive regimen is prone to change within the first year of kidney transplantation. Further studies are needed to evaluate the benefits and risks in patients who changed immunosuppressants.
Highlights
The introduction of calcineurin inhibitors (CNIs) in clinical practice much improved the short-term graft survival rates, but its effects in long-term graft longevity were not significant in kidney transplantation (KT) recipients [1]
The triple therapy including calcineurin inhibitor, mycophenolic acid, and steroids was the major initial maintenance immunosuppression (n = 518, 81.4%), but its proportion decreased by 14% (81.4% to 67.5%) after 1 year
The initial immunosuppressive regimen is prone to change within the first year of kidney transplantation
Summary
The introduction of calcineurin inhibitors (CNIs) in clinical practice much improved the short-term graft survival rates, but its effects in long-term graft longevity were not significant in kidney transplantation (KT) recipients [1]. Diverse combination of protocols were developed to improve immunosuppression with minimizing side effect of CNIs., Among them, triple therapy consisting of low-dose tacrolimus (TAC), mycophenolic acid (MPA) and steroid is popular in current practice as a maintenance ISx treatment. It is not well known whether the initial immunosuppressive regimens are maintained during the posttransplant periods in real-world medical settings. The actual prescription pattern of immunosuppressive agents in kidney transplantation is unclear
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