Tacrolimus plus mycophenolate mofetil vs. cyclosporine plus everolimus in deceased donor kidney transplant recipients: three-yr results of a single-center prospective clinical trial

We compared in kidney transplantation two immunosuppressive regimens: tacrolimus plus mycophenolate mofetil (MMF) (TAC) and everolimus plus low-dose cyclosporine (EVE). Sixty consecutive patients received TAC (30 patients) or EVE (30 patients) as immunosuppressive regimen; all subjects also received induction with basiliximab and corticosteroids. After three-yr follow-up, no difference was found in patient and graft survival (PTS: TAC: 97% vs. EVE: 100%; GS: TAC: 93% vs. EVE: 93%). The incidence of acute rejection was higher in the EVE group but the difference was not statistically significant (17% vs. 23%, p=ns). Patients in EVE showed higher serum cholesterol (205 +/- 41 vs. 235 +/- 41mg/dL, p=0.0012) and lower hemoglobin concentration (13.6 +/- 1.4 vs. 12.4 +/- 1.9, p=0.01). Renal function was not significantly different in the two groups (3 Y creatinine: TAC 1.4 +/- 0.8 vs. EVE 1.6 +/- 0.8mg/dL, p=ns). Treatment discontinuation was higher in the EVE group (TAC 17 vs. EVE 36%, p=ns). Our data show that in the middle-term follow-up, an immunosuppressive regimen with tacrolimus plus MMF has a similar efficacy and safety profile in comparison with the combination of low-exposure cyclosporine plus everolimus. Further follow up could evidence the benefits related to the anti-proliferative effects of everolimus.