Effectiveness and safety of immunosuppressive regimens used as maintenance therapy in kidney transplantation: The CESIT study

• DOI: 10.1371/journal.pone.0295205
• Publication Date: 2024-01-02T19:27:17Z
• Authors: Arianna Bellini; Marco Finocchietti; Alessandro Cesare...; Maurizio Nordio; Eliana Ferroni; Marco Massari; Stefania Spila Al...; Lucia Masiero; Gaia Bedeschi; Massimo Cardillo; Ersilia Lucenteforte; Giuseppe Piccolo; Olivia Leoni; Silvia Pierobon; Stefano Ledda; Donatella Garau; Marina Davoli; Antonio Addis; Valeria Belleudi
• Keywords: Immunosuppression

Maintenance immunosuppressive therapy used in kidney transplantation typically involves calcineurin inhibitors, such as tacrolimus or cyclosporine, combination with mycophenolate mechanistic target of rapamycin (mTORi) without corticosteroids. An Italian retrospective multicentre observational study was conducted to investigate the risk-benefit profile different regimens. We identified all subjects who underwent transplant between 2009 and 2019, using healthcare claims data. Patients on cyclosporine tacrolimus-based therapies were matched 1:1 based propensity score, effectiveness safety outcomes compared Cox models (HR; 95%CI). Analyses also comparing mTORi versus among tacrolimus-treated patients. treated had a higher risk rejection graft loss (HR:1.69; 95%CI:1.16–2.46) incidence severe infections (1.25;1.00–1.55), but lower diabetes (0.66;0.47–0.91) those tacrolimus. Among users, showed non-inferiority MMF terms mortality (1.01;0.68–1.62), reject/graft (0.61;0.36–1.04) (0.76;0.56–1.03). In real-life setting, appeared be superior reducing infections, albeit an associated increased diabetes. The may represent valid alternative mycophenolate, although further studies are needed confirm this finding.