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. 2023 May;30(5):483-491.
doi: 10.1111/iju.15163. Epub 2023 Feb 16.

Long-term prolonged-release tacrolimus outcomes in living donor kidney transplantation: The Japan Academic Consortium of Kidney Transplantation study-II

Masayoshi Okumi  1   2 , Kazuya Omoto  2 , Tomokazu Shimizu  3 , Hiroki Shirakawa  4 , Kohei Unagami  5 , Takumi Lee  6 , Hideki Ishida  5 , Kazunari Tanabe  7 , Toshio Takagi  2
Affiliations

Long-term prolonged-release tacrolimus outcomes in living donor kidney transplantation: The Japan Academic Consortium of Kidney Transplantation study-II

Masayoshi Okumi et al. Int J Urol. 2023 May.

Abstract

Objectives: To evaluate the 10-year efficacy and safety of a prolonged-release tacrolimus-based combination immunosuppressive regimen on longer-term outcomes in living donor kidney transplantation.

Methods: Data from Japanese living donor kidney transplant recipients (n = 410) maintained on continuous prolonged-release tacrolimus-based immunosuppression from 2009-2013 were analyzed with a median follow-up of 9.9 years.

Results: A prolonged-release, tacrolimus-based combination regimen provided death-censored graft failure and all-cause death rates at 10 years of 7.0% and 6.8%, respectively. In multivariable analyses, acute and chronic rejection and 'throughout' (new-onset plus preexisting) diabetes mellitus were risk factors for death-censored graft failure. Recipient age ≥ 65 years, throughout diabetes mellitus and malignancy were common risk factors for all-cause death. Throughout diabetes mellitus was the most common risk factor for both death-censored graft failure and all-cause death. Additional analyses showed 10-year cumulative rates of death-censored graft failure were 14.0% and 5.4% for recipients with or without preexisting diabetes mellitus, respectively (log-rank test: p = 0.009). All-cause death rates were 12.7% and 5.4% in the preexisting and non-diabetes mellitus groups, respectively (log-rank test: p = 0.023).

Conclusions: In this real-world, retrospective, living donor kidney transplantation study, a prolonged-release tacrolimus-based immunosuppressive combination regimen provided 10-year death-censored graft failure rates of 14.0% and 5.4% in diabetes mellitus and non-diabetes mellitus patients, respectively; Similarly, 10-year all-cause death rates were 12.7% and 5.4% in diabetes mellitus and non-diabetes mellitus patients, respectively. To our knowledge, the data in this study are the first to provide 10-year transplant outcomes in living donor kidney transplant recipients under prolonged-release tacrolimus-based regimen.

Keywords: calcineurin inhibitor; diabetic kidney disease; kidney transplantation; long-term outcomes; new-onset diabetes mellitus after transplantation; posttransplant diabetes mellitus; preexisting diabetes; prolonged-release tacrolimus.

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References

REFERENCES

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    1. Okumi M, Unagami K, Kakuta Y, Ochi A, Takagi T, Ishida H, et al. Elderly living donor kidney transplantation allows worthwhile outcomes: the Japan academic consortium of kidney transplantation study. Int J Urol. 2017;24:833-40.
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