Reduced-dose Cyclosporine with Mycophenolate Mofetil and Prednisone Significantly Improves the Long-term Glomerular Filtration Rate and Graft Survival

Abstract

It remains debated whether reduced doses of chronic calcineurin inhibitors benefit graft survival. This retrospective study analyzed 60 first cadaveric renal transplant recipients who received cyclosporine (CSA), mycophenolate mofetil (MMF) and prednisone (CMP group) and 71 recipients who received reduced-dose CSA with prednisone and MMF (RCMP group). All recipients were followed for at least 96 months. The Modification of Diet in Renal Disease (MDRD) glomerular filtration rate (GFR) calculated at different time points, graft survival, the incidence of chronic allograft nephropathy (CAN) and the acute rejection rate within six months were analyzed and compared between the two groups. The incidence of acute rejection within six months post-transplant was 15.5% (11/71) in the RCMP group and 13.3% (8/60) in the CMP group. This difference was not significant (p=0.727). The MDRD-calculated GFR in the CMP group reached a peak at 24 months post-transplant (66.6 ± 20.2 mL/min/1.73 m(2)) then decreased gradually. In contrast, in the RCMP group, the GFR reached a peak at 36 months post-transplant (76.9 ± 19.6 mL/min/1.73 m(2)). The GFR from month 36 to month 96 was significantly higher in the RCMP group than in the CMP group. The Kaplan-Meier calculated death-censored graft survival in the RCMP group was significantly higher than that observed in the CMP group, with an estimated cumulative proportion surviving at 96 months of 95.5% in the RCMP group and 83.5% in the CMP group. The incidence of CAN within 96 months was 5.6% (4/71) in the RCMP group vs. 16.7% (10/60) in the CMP group (p=0.042). An RCMP regimen can significantly improve the long-term GFR level and benefit graft survival.