Primary immunosuppression and outcome differences after heart transplantation: tacrolimus versus cyclosporine.

The superiority of tacrolimus (Tac) as primary immunosuppression for heart transplantation (HT) compared with cyclosporine (CsA) is still under debate. Outcomes of comparison studies are not consistent; the duration of these studies has been limited. The aim of this study was to evaluate long-term outcomes of patients undergoing HT based on primary immunosuppression regime. We analyzed a single-center registry of all HT patients between 1998 and 2009, comparing outcomes based on primary immunosuppressions (Tac or CsA). Patients who died before starting immunosuppression were excluded. A total of 197 patients entered the study; 103 received Tac and 94 CsA. There were no differences between groups in baseline characteristics, United Network for Organ Sharing status 1A or ventricular assist device use, except for ischemia time (195 ± 50 min in Tac group vs 182 ± 55 min in CsA; P = .08) and days on waiting list (164 ± 155 vs 100 ± 73; P < .001). After mean follow-ups of 4.5 ± 2.3 years in the Tac group and 6.3 ± 4.3 years in the CsA group, there were 19 and 36 deaths, respectively. Kaplan-Meier analysis showed increased survival for the Tac group (log rank P = .04). Tac also was significantly superior to CsA regarding mortality (relative risk 0.55; 95% confidence interval, 0.31-0.98; P = .04). In our series the use of tacrolimus resulted in improved long-term survival compared with cyclosporine. At 1-year follow-up, there were no differences in acute rejection episodes or the appearance of vasculopathy.

Castel MA ，Farrero M ，Vallejos I ，Cardona M ，Regueiro A ，Pérez-Villa F ... -  《-》

Ten-year results of a randomized trial comparing tacrolimus versus cyclosporine a in combination with mycophenolate mofetil after heart transplantation.

Guethoff S ，Meiser BM ，Groetzner J ，Eifert S ，Grinninger C ，Ueberfuhr P ，Reichart B ，Hagl C ，Kaczmarek I ... -  《-》

Better actual 10-year renal transplant outcomes of 80% reduced cyclosporine exposure with sirolimus base therapy compared with full cyclosporine exposure without or with concomittant sirolimus treatment.

Retrospective analysis of 10-year outcomes of sirolimus (SRL) plus varying exposure to cyclosporine (CsA) in combination therapy for renal transplantation. Univariate, multivariate, and receiver operating characteristic (ROC) analyses of 10-year outcomes of 167 subjects treated with full exposures to CsA/SRL/steroid versus 233 with CsA/no SRL/steroid who were generally enrolled in randomized trials versus 192 patients prescribed 80% reduced CsA exposure adjunctive to SRL baseline therapy with steroid withdrawal (groups 1, 2, and 3, respectively). Groups 1 and 3 showed greater 1-year graft survivals (GS) than group 2 (93% and 94% vs 86%; P=.05, particularly when mean SRL C0≥10.5; P=.02); fewer acute rejection episodes (11% and 19% vs 40%; P<.001) and more frequent success of steroid withdrawal (47% and 66% vs 27%; P<.0001). Group 3 versus 1 displayed a higher mean glomerular filtration rate using the Modification of Diet in Renal Disease (MDRD) formula: 56 versus 49 (P=.02) and 53 versus 41 mL/min per 1.73 m2 (P<.001) at 5 and 10 years, respectively. The 10-year GS among group 1 subjects was predicted by a ≥59 mL/min per 1.73 m2 at 1 year using ROC. Multivariate analysis showed factors predictive of 10-year GS among group 1 to include living donor source (P=.004), younger recipient age (P=.02), and fewer HLA-mismatches (P=.02). For group 3, the adverse factors were lower MDRD (P=.01); hypercholesterolemia (P=.01), and advanced donor age (P=.02). Group 3 versus 1 subjects displayed fewer skin tumors (2.6% vs 7.1%; P=.04), sepsis bouts (3.6% vs 9%; P=.04), and herpes virus infection (10% vs. 23%; P=.002), but more urinary tract infections (64% vs 53%; P=.04) and wound problems (43.7% vs 25.1%; P<.0001). An 80% reduction of de novo CsA exposure in combination with SRL engendered improved renal function as well as better graft survival at 10 years compared with patients treated with full CsA exposures with or without SRL co-therapy.

Pliszczynski J ，Kahan BD 《-》

Efficacy and safety of tacrolimus compared with cyclosporin A microemulsion in renal transplantation: 2 year follow-up results.

Krämer BK ，Montagnino G ，Del Castillo D ，Margreiter R ，Sperschneider H ，Olbricht CJ ，Krüger B ，Ortuño J ，Köhler H ，Kunzendorf U ，Stummvoll HK ，Tabernero JM ，Mühlbacher F ，Rivero M ，Arias M ，European Tacrolimus vs Cyclosporin Microemulsion Renal Transplantation Study Group ... -  《NEPHROLOGY DIALYSIS TRANSPLANTATION》

Comparison of sirolimus plus tacrolimus versus sirolimus plus cyclosporine in high-risk renal allograft recipients: results from an open-label, randomized trial.

Gaber AO ，Kahan BD ，Van Buren C ，Schulman SL ，Scarola J ，Neylan JF ，Sirolimus High-Risk Study Group ... -  《-》