Long-term outcomes in rapamycin on renal allograft function: a 30-year follow-up from a single-center experience

To evaluate long-term renal graft prognosis and the role of rapamycin from a single-center in China over a 30-year follow-up. This study enrolled a total of 654 patients who underwent kidney transplantation between 1989 and 2020. The basic characteristics of the included patients were collected. Gra...

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Published in:BMC nephrology 2024-09, Vol.25 (1), p.311-10, Article 311
Main Authors: Ji, Yisheng, Sun, Li, Fei, Shuang, Gao, Xiang, Chen, Hao, Han, Zhijian, Tao, Jun, Ju, Xiaobing, Wang, Zijie, Tan, Ruoyun, Gu, Min
Format: Article
Language:English
Subjects:
Adult
Albumen
Biopsy
Creatinine
Dialysis
Drug Therapy, Combination
Female
Follow-Up Studies
Globulins
Graft rejection
Graft Rejection - prevention & control
Graft Survival
Hemodialysis
Humans
Immunosuppression
Immunosuppressive agents
Immunosuppressive Agents - therapeutic use
Immunotherapy
Inflammation
Kidney diseases
Kidney Transplantation
Kidney transplants
Kidneys
Male
Medical prognosis
Middle Aged
Mortality
Patient outcomes
Patients
Peritoneal dialysis
Prediction model
Prognosis
Proportional Hazards Models
Rapamycin
Renal function
Retrospective Studies
Risk factors
Sirolimus - therapeutic use
Surgery
Survival
Tacrolimus
Tacrolimus - therapeutic use
Time Factors
Transplantation
Variance analysis
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container_end_page 10
container_issue 1
container_start_page 311
container_title BMC nephrology
container_volume 25
creator Ji, Yisheng
Sun, Li
Fei, Shuang
Gao, Xiang
Chen, Hao
Han, Zhijian
Tao, Jun
Ju, Xiaobing
Wang, Zijie
Tan, Ruoyun
Gu, Min
description To evaluate long-term renal graft prognosis and the role of rapamycin from a single-center in China over a 30-year follow-up. This study enrolled a total of 654 patients who underwent kidney transplantation between 1989 and 2020. The basic characteristics of the included patients were collected. Graft survival was described and compared using Kaplan-Meier curves (K-M curves). Both continuous and categorical variables were included in a multivariate Cox proportional-hazards model. Patients were divided into rapamycin-based quadruple immunosuppression regimen group (rapa group, n = 41) and conventional tacrolimus-based triple immunosuppression regimen group (control group, n = 218). The indication biopsy results of the two groups were further reviewed to compare the incidence of rejection, acute rejection, and banff score. The overall 5, 10, 15, 20-year graft survival rate of our center is 87.5%, 62.4%, 46.4% and 20.9%, respectively. The median survival time after surgery is 14 years. Multiple Cox regression analysis identified BMI (p = 0.035), dialysis type (p 
doi_str_mv 10.1186/s12882-024-03730-8
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This study enrolled a total of 654 patients who underwent kidney transplantation between 1989 and 2020. The basic characteristics of the included patients were collected. Graft survival was described and compared using Kaplan-Meier curves (K-M curves). Both continuous and categorical variables were included in a multivariate Cox proportional-hazards model. Patients were divided into rapamycin-based quadruple immunosuppression regimen group (rapa group, n = 41) and conventional tacrolimus-based triple immunosuppression regimen group (control group, n = 218). The indication biopsy results of the two groups were further reviewed to compare the incidence of rejection, acute rejection, and banff score. The overall 5, 10, 15, 20-year graft survival rate of our center is 87.5%, 62.4%, 46.4% and 20.9%, respectively. The median survival time after surgery is 14 years. Multiple Cox regression analysis identified BMI (p = 0.035), dialysis type (p < 0.001), immunosuppressants (p < 0.01), urine albumen (p < 0.001), globulin (p = 0.041), and blood glucose (p = 0.002) as risk factors. The 20-year, 10-year and 5-year AUC is 0.78, 0.75 and 0.75. The combination of FK506 and rapamycin was further suggested by the model to effectively improve the graft prognosis (p < 0.01, HR = 0.763). The K-M curve showed that the long-term survival rate of renal grafts in the rapa group was significantly better than that in the conventional group (p < 0.001). In addition, indication biopsy records revealed a lower possibility of immune rejection in the rapa group than that in the conventional group (p < 0.001). Banff score indicated that rapa group had less vascular inflammation in the transplanted kidney. In this study, a 30-year follow-up was performed in a single center, and a total graft 20-year survival rate of 20.9% was reported. The prognostic model and subgroup analysis suggested that FK506 combined with rapamycin could effectively improve the prognosis of renal transplantation, which could be explained by reduced acute rejection and less vascular inflammation.]]></description><identifier>ISSN: 1471-2369</identifier><identifier>EISSN: 1471-2369</identifier><identifier>DOI: 10.1186/s12882-024-03730-8</identifier><identifier>PMID: 39294598</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Albumen ; Biopsy ; Creatinine ; Dialysis ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Globulins ; Graft rejection ; Graft Rejection - prevention &amp; control ; Graft Survival ; Hemodialysis ; Humans ; Immunosuppression ; Immunosuppressive agents ; Immunosuppressive Agents - therapeutic use ; Immunotherapy ; Inflammation ; Kidney diseases ; Kidney Transplantation ; Kidney transplants ; Kidneys ; Male ; Medical prognosis ; Middle Aged ; Mortality ; Patient outcomes ; Patients ; Peritoneal dialysis ; Prediction model ; Prognosis ; Proportional Hazards Models ; Rapamycin ; Renal function ; Retrospective Studies ; Risk factors ; Sirolimus - therapeutic use ; Surgery ; Survival ; Tacrolimus ; Tacrolimus - therapeutic use ; Time Factors ; Transplantation ; Variance analysis</subject><ispartof>BMC nephrology, 2024-09, Vol.25 (1), p.311-10, Article 311</ispartof><rights>2024. The Author(s).</rights><rights>COPYRIGHT 2024 BioMed Central Ltd.</rights><rights>2024. This work is licensed under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3608-230cb388747182974310daef3dfb44eff3c729e278c5ce3bb47743e5f0533c6a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11411783/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3115125329?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39294598$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ji, Yisheng</creatorcontrib><creatorcontrib>Sun, Li</creatorcontrib><creatorcontrib>Fei, Shuang</creatorcontrib><creatorcontrib>Gao, Xiang</creatorcontrib><creatorcontrib>Chen, Hao</creatorcontrib><creatorcontrib>Han, Zhijian</creatorcontrib><creatorcontrib>Tao, Jun</creatorcontrib><creatorcontrib>Ju, Xiaobing</creatorcontrib><creatorcontrib>Wang, Zijie</creatorcontrib><creatorcontrib>Tan, Ruoyun</creatorcontrib><creatorcontrib>Gu, Min</creatorcontrib><title>Long-term outcomes in rapamycin on renal allograft function: a 30-year follow-up from a single-center experience</title><title>BMC nephrology</title><addtitle>BMC Nephrol</addtitle><description><![CDATA[To evaluate long-term renal graft prognosis and the role of rapamycin from a single-center in China over a 30-year follow-up. 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This study enrolled a total of 654 patients who underwent kidney transplantation between 1989 and 2020. The basic characteristics of the included patients were collected. Graft survival was described and compared using Kaplan-Meier curves (K-M curves). Both continuous and categorical variables were included in a multivariate Cox proportional-hazards model. Patients were divided into rapamycin-based quadruple immunosuppression regimen group (rapa group, n = 41) and conventional tacrolimus-based triple immunosuppression regimen group (control group, n = 218). The indication biopsy results of the two groups were further reviewed to compare the incidence of rejection, acute rejection, and banff score. The overall 5, 10, 15, 20-year graft survival rate of our center is 87.5%, 62.4%, 46.4% and 20.9%, respectively. The median survival time after surgery is 14 years. Multiple Cox regression analysis identified BMI (p = 0.035), dialysis type (p < 0.001), immunosuppressants (p < 0.01), urine albumen (p < 0.001), globulin (p = 0.041), and blood glucose (p = 0.002) as risk factors. The 20-year, 10-year and 5-year AUC is 0.78, 0.75 and 0.75. The combination of FK506 and rapamycin was further suggested by the model to effectively improve the graft prognosis (p < 0.01, HR = 0.763). The K-M curve showed that the long-term survival rate of renal grafts in the rapa group was significantly better than that in the conventional group (p < 0.001). In addition, indication biopsy records revealed a lower possibility of immune rejection in the rapa group than that in the conventional group (p < 0.001). Banff score indicated that rapa group had less vascular inflammation in the transplanted kidney. In this study, a 30-year follow-up was performed in a single center, and a total graft 20-year survival rate of 20.9% was reported. The prognostic model and subgroup analysis suggested that FK506 combined with rapamycin could effectively improve the prognosis of renal transplantation, which could be explained by reduced acute rejection and less vascular inflammation.]]></abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>39294598</pmid><doi>10.1186/s12882-024-03730-8</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
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1471-2369
language eng
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source Publicly Available Content Database; PubMed Central
subjects Adult
Albumen
Biopsy
Creatinine
Dialysis
Drug Therapy, Combination
Female
Follow-Up Studies
Globulins
Graft rejection
Graft Rejection - prevention & control
Graft Survival
Hemodialysis
Humans
Immunosuppression
Immunosuppressive agents
Immunosuppressive Agents - therapeutic use
Immunotherapy
Inflammation
Kidney diseases
Kidney Transplantation
Kidney transplants
Kidneys
Male
Medical prognosis
Middle Aged
Mortality
Patient outcomes
Patients
Peritoneal dialysis
Prediction model
Prognosis
Proportional Hazards Models
Rapamycin
Renal function
Retrospective Studies
Risk factors
Sirolimus - therapeutic use
Surgery
Survival
Tacrolimus
Tacrolimus - therapeutic use
Time Factors
Transplantation
Variance analysis
title Long-term outcomes in rapamycin on renal allograft function: a 30-year follow-up from a single-center experience
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