The impact of reduced immunosuppression on graft outcomes in elderly renal transplant recipients

Melissa Badowski, Cheryle Gurk-Turner, Charles Cangro, Matthew Weir, Benjamin Philosophe, David Klassen, Abdolreza Haririan

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Optimal immunosuppression (IS) for elderly kidney transplant recipients is unknown. We conducted a retrospective cohort study of recipients aged 60 yr or older to examine the impact of reduced IS on graft outcomes. Group 1 patients (n = 101) were initiated on mycophenolate mofetil 2 g/d and tacrolimus, target level 10-12 ng/mL; Group 2 patients (n = 88) with 1 g/d and 8-10 ng/mL, respectively. Dose adjustments were made as required. The groups were comparable except for diabetes, end-stage renal disease duration, and induction. Mycophenolate mofetil dose was reduced in 62% and 38% of the patients, respectively (p < 0.01). Patients were followed for 23.8 ± 14.2 and 21.3 ± 11.8 months post-transplant (p = 0.2). Twenty-seven cases in Group 1 (26.7%) and eight in Group 2 (9.1%) lost their grafts (p = 0.01); 19 (18.8%) and 7 (8.0%) cases in each group because of death, respectively (p = 0.09). Sixteen patients in Group 1 (15.8%) and 18 in Group 2 (20.5%) experienced acute rejection (p = 0.36). Patients in Group 2 had a lower risk of graft loss compared with those in Group 1 [adjusted hazard ratio (HR): 0.27, p = 0.006, 95% CI: 0.11-0.69]. There were no significant differences between the groups regarding graft function, BK virus nephropathy, and CMV infection. Our results suggest that reduction in overall IS in this group was associated with improved graft and patient survival.

Original languageEnglish (US)
Pages (from-to)930-937
Number of pages8
JournalClinical Transplantation
Volume23
Issue number6
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Keywords

  • Elderly
  • Immunosuppression
  • Kidney transplantation
  • Mycophenolate mofetil
  • Outcome
  • Tacrolimus

ASJC Scopus subject areas

  • Transplantation

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