Long-term kidney transplant outcomes in patients receiving oil-based or microemulsion formulations of cyclosporine

Abstract

In the last 20 years long-term experience with cyclosporine use in kidney transplantation has increased, allowing a more precise identification of its benefits. Methods We performed a retrospective analysis of 1619 kidney transplants that received cyclosporine-based immunosuppressive therapy. Patients were divided into three groups (1) oil-based cyclosporine (SIM) with trough monitoring (GI, n = 617); (2) microemulsion formulation (NEO) with trough monitoring (GII, n = 962); and (3) NEO with C2 monitoring (GIII, n = 40). Information was obtained on transplant demography; adjunctive immunosuppressive agent; living (LD) versus cadaveric (CAD) recipients; delayed graft function; any treated acute rejection; graft function at 3, 6, and 12 months, patient and graft survival, as well as causes of graft loss and death. Results At 15 years follow-up, patient and graft survival were 67.5% and 41.6%, being superior, among LD versus CAD recipients (patient: 78.7% vs 57.7%, P < .001; graft: 56.4% vs 30.5%, P < .001). In LD (54% vs 32%, P < .001) and CAD (69% vs 55%, P < .001) NEO reduced the incidence of AR and improved 8-year patient (LD: 81.8% vs 94.7%; CAD: 66.4 vs 79.9%, P < .01) and graft survival (LD: 58.3 vs. 80%; CAD: 40.2% vs. 59.5%, P < .01), compared to SIM. Overall 8-year graft survival was inferior among patients with increased 1-year creatinine values (≤1.5, 1.6–2.5 and >2.5 mg/dL) level (74% vs 63.9% vs 22.4%, P < .001) or change in Cr (≤0.1, 0.2–0.4, >0.5 mg/dL) level (73.1% vs 61.9% vs 37.2%, P < .001). In patients at the same level of graft function, those receiving NEO showed superior 8-year patient and graft survival compared with SIM. Conclusion Compared to SIM, NEO reduced the incidence of acute rejection and produced superior long-term patient and graft survival.