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 tacrolimus based vs. cyclosporine based immunosuppressant regimens among low-risk kidney transplant recipients with living donors.
Patient and methods: Out of 3600 living kidney transplant recipients who were followed up in Hamed Al-Essa organ transplant centre in Kuwait, 660 patients received their grafts from living donors under low immunological risk during the period between 2010 and 2023. In this retrospective study, patients were divided into two groups: group 1, patients maintained on Tacrolimus-based therapy (n=328 patients) and group 2, patients maintained on cyclosporine-based therapy (n=332 patients). The two groups were compared regarding their basal characteristics and their post-transplant outcome.
Results: Most patients were Kuwaiti males with their mean age 42.2±17.2 years without significant difference between the two groups, and most of them reached end stage kidney disease due to diabetic nephropathy or chronic GN (p>0.05). The two groups were comparable regarding their demographics (dialysis mode, virology profile, IHD, DM, and hyperlipidaemia) apart from significantly higher number of HCV and TB sensitized patients in group 2(p<0.05). We found significantly higher prevalence of post-transplant CMV viremia in group 2(p=0.046). Despite the significantly better immediate graft function in group 2, comparable number of rejection episodes, BK viremia, PTDM, and malignancies; the graft function and outcome were significantly worse in the same group (p<0.05) however, patient outcome was comparable in the two groups.
Conclusion: In low risk kidney transplant recipients with living donor, tacrolimus based immunosuppression is associated with better graft outcome without significant impact on patient outcome.