Sirolimus improves the two-year outcome of renal allografts in African-American patients

Abstract

The present study evaluated whether the addition of sirolimus to a cyclosporine (CyA)/prednisone (Pred) regimen mitigated the greater proclivity to acute rejection episodes and graft loss characteristic of African-American renal transplant recipients. Using Kaplan-Meier and log-rank tests, African-American renal transplant recipients treated with either CyA/Pred (n = 90) or sirolimus/CyA/Pred (n = 47) were compared with 120 Caucasian patients treated with sirolimus/CyA/Pred for 2-year rates of patient and graft survival as well as acute rejection episodes. Mean laboratory values were compared using analysis of variance and F-tests. Addition of sirolimus to the CyA/Pred regimen reduced the incidence of acute rejection episodes in African-Americans from 43.3% to 19.2% (P = 0.004), a value similar to Caucasian patients. The 97.9% 2-year graft survival rate among 47 African-American patients treated with sirolimus/CyA/Pred was significantly higher than the 85.6% rate shown among the 90 CyA/Pred-treated African-American transplant recipients (P = 0.0479) and similar to that in Caucasians. The 95.7% patient survival rate among the African-American sirolimus/CyA/Pred group was similar to the 97.8% rate in the African-American CyA/Pred cohort. Interestingly, there was no evident toxicity from the addition of sirolimus. The addition of sirolimus to a CyA-based regimen reduced acute rejection episodes and graft loss experienced by African-American renal transplant recipients.

Long-Term Renal Allograft Survival: Have we Made Significant Progress or is it Time to Rethink our Analytic and Therapeutic Strategies?

“…We believe that the reason for this is that in these 2 groups, African Americans and re‐transplants, there was more room for improvement especially in preventing graft loss secondary to acute rejection. In fact it has been shown repeatedly that improvements in immunosuppressive regimens have a proportionally higher beneficial impact in high risk recipients like African Americans (5–7). Now that sufficient data has accumulated to calculate half‐lives of transplant kidneys based on real data, it becomes clear that earlier projections of half‐lives were overestimating the half‐lives but also implying a trend which is really only true for a fraction of patients.…”

Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

“…The copyright line for this article was changed on 23 August 2018 after original online publication. disparities in AAs have traditionally been explained by higher immunologic risks leading to higher rejection rates, [3][4][5][6] socioeconomic status (SES) barriers, 7,8 increased medication nonadherence, 9,10 and a higher prevalence and progression of comorbidities. [11][12][13] Previous racial disparities research in kidney transplantation has focused on understanding and mitigating immunologic and SES risks.…”

The Rocky Road of Limited Immunosuppression for Renal Transplantation in African Americans

“…The same group had a two-year graft survival of 79%, comparable to 80% in whites (26). However, as the number of AA recipients in the SIR/CSA/prednisone group increased from 47 to 86, the graft survival at two years dropped from 97.9% when initially reported to 79% (26,27). In a study designed to determine the optimal dosage combinations of TAC and SIR in 39 high-risk DD renal transplant recipients (of whom 79% were African Americans), 16 received standard TAC (trough level of 10 -15 ng/ml) plus reduced SIR (trough levels of 5-10 ng/ml), and 23 received reduced TAC (trough levels of 5-10 ng/ml) plus standard SIR (trough levels of 10 -15 ng/ml) (28).…”