Switching immunosuppression medications after renal transplantation—a common practice

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2006-08, Vol.21 (8), p.2256-2262
• Main Authors: Meier-Kriesche, Herwig-Ulf, Chu, Alice H., David, Kristin M., Chi-Burris, Katherine, Steffen, Bettina J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Calcineurin Inhibitors; California; Cohort Studies; Continental Population Groups; Cyclosporine - administration & dosage; Cyclosporine - therapeutic use; Drug Therapy, Combination; Drug Utilization; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Graft Rejection - prevention & control; Graft Survival; Graft vs Host Disease - prevention & control; Humans; immunosuppression; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - classification; Immunosuppressive Agents - therapeutic use; Intensive care medicine; Kaplan-Meier Estimate; Kidney Transplantation; Male; Medical sciences; Middle Aged; mycophenolate mofetil; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Patient Discharge - statistics & numerical data; Postoperative Period; Practice Patterns, Physicians' - statistics & numerical data; Renal failure; renal transplantation; Reoperation; Risk Factors; Sirolimus - administration & dosage; Sirolimus - therapeutic use; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; tacrolimus; Tacrolimus - administration & dosage; Tacrolimus - therapeutic use; Tissue Donors
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfl134

Background. The rate of change to immunosuppression discharge regimens over time is unknown. We examined the frequency of changes to initial drug treatment regimens and factors associated with a drug change following renal transplantation. Methods. Scientific Registry of Transplant Recipients data from adult recipients who underwent primary renal transplantation between January 1998 and December 2002 were analysed. The Kaplan–Meier analysis was used to determine the frequency of regimen changes for the most common immunosuppression discharge regimens, type of change, and to examine switching between the calcineurin inhibitors tacrolimus (Tacro) and ciclosporin United States Pharmacopera (USP) modified (CsA). Cox proportional hazard regression was used to examine recipient, donor and transplant characteristics associated with a drug change. Results. The majority of patients experienced a change to their discharge regimen post-transplantation, and more changes were observed within higher-risk sub-groups of patients. Switching from CsA to Tacro was more common than Tacro to CsA. Significant factors associated with a drug change included those associated with graft loss. Conclusions. Significant immunosuppression regimen changes occur during the first 4 years post-transplantation. It is possible that early graft survival benefits proven in prospective clinical trials may not translate into long-term success in clinical practice, possibly in part because efficacious regimens are not necessarily maintained long-term.