Efficacy and Safety of Immunosuppressive Drugs in Kidney Transplant Recipients in Sunpasitthiprasong Hospital
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Abstract
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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