Maintenance immunosuppression.

Abstract

An "intent-to-treat" analysis was developed to examine the administration of primary and adjunctive immunosuppressive agents by year of transplant for unsensitized, sensitized, multi-organ and living donor transplant recipients by centers reporting to the UNOS Registry of Renal Transplant Recipients. Based on these analyses, several trends were noted: Tacrolimus became the dominant primary agent for multi-organ transplant recipients in 1998, sensitized recipients in 2000, and unsensitized and living-donor transplant recipients in 2001. MMF became the dominant adjunctive agent for all transplants studied in 1996. The combination of CsA-MMF was most often administered to unsensitized and living donor recipients while Tac-MMF was most often used for multi-organ transplants. The trend of decreasing rejection rates from 60% in 1996 to 20% in 2001 was similar for each type of transplant studied. Rejection rates were highest with the Csa-Aza combination and lowest with the Tac-MMF combination. Combinations with the lowest rates of rejection did not necessarily have the highest graft outcome. HLA matching decreased rejection rates and improved graft outcome for each type of transplant and immunosuppression combination. Graft outcome in HLA-matched living donor transplants was highest with the less potent CsA-Aza combination and lowest with the Tac-MMF combination. Treatment crossover from CsA to Tac or Aza to MMF was least frequent among HLA-matched recipients. Crossover from MMF to Aza was highest in HLA-matched living donor transplants.