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NDT Advance Access published online on March 30, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl134
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received December 22, 2005
Accepted March 2, 2006

Original Article

Switching immunosuppression medications after renal transplantation--a common practice

Herwig-Ulf Meier-Kriesche 1 *, Alice H. Chu 2, Kristin M. David 2, Katherine Chi-Burris 2, and Bettina J. Steffen 2

1 Department of Internal Medicine, University of Florida, USA
2 ProSanos Corporation, La Jolla, California, USA

* To whom correspondence should be addressed.
Herwig-Ulf Meier-Kriesche, E-mail: Meierhu{at}medicine.ufl.edu



  Abstract

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.

Keywords: immunosuppression; mycophenolate mofetil; renal transplantation; tacrolimus.
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