30-Year Retrospective on Organ Transplant Immunosuppress.ppt

Relative risk for overall allograft loss, by organ donor type (1995-2000). Deceased-donor kidney transplants demonstrated a slight elevation in risk, whereas risk estimates in live-donor transplants were flat by year of transplantation. * The 6-year overall unadjusted graft survival rates by renal function status (estimated glomerular filtration rate) and return to baseline function after rejection. * The 1-year allograft survival rate improved steadily from 1975 to 1990, whereas the allograft half-life remained unchanged. * Kaplan-Meier plots for overall allograft survival in primary deceased-donor transplant recipients show separation in the early post-transplant period, but narrow over the long term, resulting in relatively similar half-lives. * Overall allograft survival by discharge immunosuppressive regimen for deceased-donor transplant recipients. The SRL/MMF regimen was associated with significantly reduced overall allograft survival compared with other regimens (log-rank P .001). * Mean on-therapy glomerular filtration rates calculated using the Nankivell method were significantly better in recipients treated with sirolimus plus steroids than in recipients treated with a combination of sirolimus, cyclosporine, and steroids from months 6 through 48 (54.5 mL/min/1.73 m2 vs 68.6 mL/min/1.73 m2, P .001). * For the Kaplan-Meier estimates of event rates, data for patients who completed the study according to protocol before the first year after transplantation were censored at the time of their last visit. (Left side) Allograft survival in the low-dose tacrolimus group was significantly higher than in the standard-dose cyclosporine group and the low-dose sirolimus group (P = .007). (Right side) At 6 and 12 months, the incidence of biopsy-proven acute rejection except in borderline cases in the low-dose tacrolimus group was approximately half that in the standard-dose and low-dose cyclosporine groups, and approximately one third that in the low-dose sirolimus