Calcineurin Inhibitor-Based Immunosuppressive Therapy, Donor Age, and Long-Term Outcome After Kidney Transplantation

Background. It is unclear whether the choice of maintenance immunosuppression modulates the negative effect of advanced donor age on Outcome after renal transplantation. Methods. All 1829 patients who received their first transplant between 1990 and 2003 at the Vienna Medical Centre and had a functioning graft after 90 days were studied. At this time point, 1587 received calcineurin inhibitors (CNI+), 242 did not (CNI-). Actual and functional graft survival was analyzed in subgroups based on donor age (<36, 36-49, 50-64, and >64 years) and immunosuppressive therapy. Results. The median follow-up time was 7 years. In total, we observed 312 deaths and 275 graft losses. After adjusting for several variables considered as potential confounders, actual graft survival was better in CNI+ patients compared with CNI- patients only if donor age was less than 36 years (adjusted hazard ratio 0.25, 95% confidence interval 0.17-0.38) or 36 to 49 years (0.43, 95% confidence interval 0.29-0.62). Similar results were obtained for functional graft survival. Patient survival was significantly better in CNI+ subjects irrespective of donor age (0.41, 95% confidence interval 0.30-0.57). Discussion. Use of CNI 90 days after transplantation is associated with improved patient survival even after adjustment for confounders, but its beneficial association with actual and functional graft Survival is lost or at least reduced if kidneys from donors older than 50 years are used.