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Introduction: Immunosuppressive drugs play a major role for prevention of acute graft rejection in kidney transplant patient. However, graft rejection can still occur despite a proper immunosuppressive therapy. Objective: The purpose of this study was to investigate the efficacy and safety of immunosuppressive drugs among kidney transplant patients. The primary outcome was the graft rejection rate. The secondary outcomes were the rate of adverse drug events, renal function, patient survival, and graft survival. Methods: A retrospective study was conducted among 132 kidney transplant patients who were follow-up at dialysis unit, Sunpasitthiprasong hospital during January 1, 1998 to October 31, 2016. All eligible patients were grouped based on the immunosuppressive regimen. Results: Among overall 103 included patients, the mean age was 40 years old and 68.9% of them were male. Of these, 83.5% had received a cadaveric kidney transplant. Cyclosporine, tacrolimus, and everolimus were given as an initial immunosuppressive regimen in 9, 89, and 5 patients, respectively. Whereas 2, 85, and 16 patients had received maintenance immunosuppressive regimen with cyclosporine, tacrolimus, and everolimus, respectively. The mean serum creatinine was 1.99±1.01 mg/dL, 1.59±0.85 mg/dL, and 1.54±0.63 mg/dL, the mean eGFR was 45.04±16.75 mL/min, 57.48±22.98 mL/min, and 69.46±23.29 mL/min along the period of the study among cyclosporine, tacrolimus, and everolimus group, respectively. The tacrolimus treated patients had significantly better renal function maintenance than cyclosporine treated patients (P<0.0001). The graft rejection was found in 6 patients (5.9%). The rate of graft rejection was not significantly different between the cyclosporine and tacrolimus group (11.1% vs. 5.6% P=0.448). At three months, the patient and graft survival rate were 97.1% and 95.1%, respectively. The patient survival rate at 1 year, 3 years, and 5 years, were 83.5%, 46.6%, and 12.6%, respectively. Adverse events had been similar between groups and almost categorized into severity grade 1 to 2. Conclusion: Cyclosporine, tacrolimus, and everolimus have a satisfactory clinical efficacy and well tolerability for prevention of acute graft rejection among kidney transplant patients. Tacrolimus seems to be an attractive option due to a better preservation of kidney function maintenance with an acceptable adverse events.
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Garcia-Garcia G. Harden P, Chapman J. The global role of kidney transplantation. Indian J Nephrol 2012;22(2):77-82.
Gill JS, Tonelli M, Mix CH, Johnson N, Pereira BJ. The effect of maintenance immunosuppression medication on the change in kidney allograft function. Kidney Int 2004;65(2):692-9.
Halloran PF. Immunosuppressive drugs for kidney transplantation. N Eng J Med 2004;351(26): 2715-29.
Hariharan S, McBride MA, Cherikh WS, Tolleris CB, Bresnahan BA, Johnson CP. Post-Transplant renal function in the first year predicts long-term kidney transplant survival. Kidney Int 2002; 62(1):311-8.
Kaufman DB, Batuman V. Assessment and management of the renal transplant patient [Internet]. New York; 2015 [cited 2016 Jun 10]. Available from: https://emedicine.medscape.com/article/429314-overview
Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009;9(Suppl 3): S1-155.
Kramer BK, Montagnino G, Castillo D, Margreiter R, Sperschneider H, Olbricht CJ. et al. Efficacy and safety of tacrolimus compared with cyclosporine A microemulsion in renal transplantation: 2 year follow-up results. Nephrol Dial Transplant 2005;20(5):968-73.
Marcen R, Fernandez-Rodriguez A, Rodriguez-Mendiola N, Ponte B, Galeano C, Villafruela JJ, et al. Evolution of rejection rates and kidney graft survival: A historical analysis. Transplantation Proceedings 2009;41(6):2357-9.
Mayer AD, Dmitrewski J, Squifflet JP, Besse T, Grabensee B, Klein B, et al. Multicenter randomized trial comparing tracrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection: a report of the European Tacrolimus Multicenter Renal Study Group. Transplantation 1997;64(3):436-43.
Mazzuchi N, Gonzalez-Martinez F, Carbonell E, Curi L, Fernandez-Cean J, Orihuela S. Comparison of survival for haemodialysis patients vs renal transplant recipients treated in Uruguay. Nephrol Dial Transplant 1999;14(12):2849-54.
McCullough KP, Keith DS, Meyer KH, Stock PG, Brayman KL, Leichtman AB. Kidney and pancreas transplantation in the United States, 1998-2007: Access for patients with diabetes and end-stage renal disease. Am J Transplant 2009;9(4 Pt 2): 894-906.
Mohammadpour N, Elyasi S, Vahdati N, Mohammadpour AH, Shamsara J. A review on therapeutic drug monitoring of immunosuppressant drugs. Iran J Basic Med Sci 2010;14(6):485-98.
Mota A. Acute rejection in cadaveric renal transplantation under cyclosporine based therapy. Acta Med Port 2004;17(1):8-14.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30(2):239-45.
National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE version 4). Published: May 28, 2009 (v4.03: June 14, 2010).
Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol 2001;12(3):589-97.
Clayton PA, Lim WH, Wong G, Chadban SJ. Relationship between eGFR decline and hard outcomes after kidney transplants. J Am Soc Nephrol 2016;27(11): 3440-46.
Solez K, Axelsen RA, Benediktsson H, Burdick JF, Cohen AH, Colvin RB, et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Banff working classification of kidney transplant pathology. Kidney Int. 1993; 44(2):411-22.
Suthanthiran M, Strom TB. Renal transplantation. N Eng J Med 1994;331(6):365-76.
Thai Transplantation Society. (2016). Report of organ transplantation of 2015. Bangkok: Wetchasan Printing House.
Thai Transplantation Society. (2017). Report of organ transplantation of 2016. Bangkok: Wetchasan Printing House.
United Network for Organ Sharing (UNOS). Data [Internet]. c2015 [cited 2016 Jun 9]. Available from: https://www.unos.org/data/transplant-trends/
Vincenti F, Jensik SC, Filo RS, Miller J, Pirsch J. A long-term comparison of tacrolimus (FK506) and cyclosporine in kidney transplantation: evidence for improved allograft survival at five years. Transplantation 2002;73(5):775-82.