Introduction: Both tacrolimus and cyclosporine function as immunosuppressants by inhibiting calcineurin, which downregulates IL-2 and other cytokine gene translations, and the two show similar graft survival rates. Some studies are still debating the use of either of them in low-risk kidney transplant patients, especially in terms of infection rates and cardiovascular risk profile.
Aim: We aimed to assess the outcome of tacrolimus-based vs. cyclosporine-based immunosuppressant regimens among kidney transplant recipients with functioning grafts beyond 15 years.
Patient and methods: Out of 3600 living kidney transplant recipients who were followed up at Hamed Al-Essa organ transplant center in Kuwait,198 patients received their grafts before the year 2008. In this retrospective study, patients were divided into two groups: group 1, patients maintained on Tacrolimus-based therapy (n=98 patients), and group 2, patients maintained on cyclosporine-based therapy (n=100 patients). The two groups were compared regarding their basal characteristics and their post-transplant outcome.
Results: Most patients were Kuwaiti males with a mean age of 35.3±14 years without a significant difference between the two groups, and most of them reached end-stage kidney disease due to chronic GN or diabetic nephropathy (p>0.05). The two groups were comparable regarding their demographics (dialysis mode, virology profile, DM, induction therapy, immediate graft function, donor type, and hyperlipidemia) apart from a significantly higher number of TB-sensitized patients in group 2(p<0.05). The two groups were comparable regarding the mean number of rejection episodes, post-transplant CMV viremia, BK viremia, PTDM, and malignancies (p>0.05). Despite the significantly higher prevalence of early ABMR episodes in group 1 and late ABMR episodes in group 2 (p=0.02), both the graft and patient outcomes were comparable in the two groups(p>0.05).
Conclusion: In kidney transplant recipients with functioning grafts beyond 15 years, Tac-based and CsA-based immunosuppressive regimens had comparable graft and patient outcomes.