Tacrolimus confers lower acute rejection rates and better renal allograft survival compared to cyclosporine

Table 1 Characteristics of patients in tacrolimus and cyclosporine group n (%)

Parameter	Cyclosporine n = 640	Tacrolimus n = 1195	P-value
Mean recipient age (yr)	49 ± 12	50 ± 13	0.059
Race			0.96
Non-African American	281 (44)	526 (44)
African-American	359 (56)	669 (56)
Sex			0.78
Male	371 (58)	693 (58)
Female	269 (42)	502 (42)
BMI	26 ± 7	28 ± 5	0.462
Etiology of kidney disease
DM	172 (26.9)	375 (31.4)	0.044
HTN	317 (49.5)	559 (46.8)	0.26
FSGS	36 (5.6)	78 (7.3)	0.177
IgA nephropathy	24 (3.8)	34 (2.8)	0.291
Polycystic kidney	63 (9.8)	89 (7.4)	0.076
History of DM	186 (29)	394 (33)	0.092
History of HTN	595 (93)	1135 (95)	0.122
History of heart disease	134 (21)	227 (19)	0.38
Years on dialysis	3 ± 2.4	3 ± 2.9	0.01
PRA	5%	17%	< 0.010
Preemptive transplant	122 (19)	239 (20)	0.49
Living donor transplant	122 (19)	179 (15)	0.27
CIT (h)	13 ± 9	16 ± 9	0.621
Mean donor age (yr)	31 ± 18	36 ± 16	< 0.010
KDRI	0.9 ± 0.6	1.3 ± 0.4	< 0.010
African-American donor	122 (19)	203 (17)	0.27
Induction therapy			< 0.010
Cytolytic agents	70 (11)	550 (46)
IL-2 receptor antagonist	570 (89)	645 (54)

DM: Diabetes mellitus; HTN: Hypertension; FSGS: Focal segmental glomerulosclerosis; PRA: Panel reactive antibody; CIT: Cold ischemia time; KDRI: Kidney donor risk index.

Table 2 Clinical outcomes

Parameter	Tacrolimus n = 1195	Cyclosporine n = 640	P-value
Mean glomerular filtration rate	56 ± 19	46 ± 17	0.09
Delayed graft function n (%)	179 (15)	115 (18)	0.049
Acute rejection (biopsy proven) n (%)	167 (14)	154 (24)	< 0.010
Three years graft survival	88%	79%	< 0.010
Five years graft survival	84%	70%	< 0.010

Table 3 Multivariate analysis of factors associated with acute rejection

Variable	Hazard ratio	95%CI	P-value
CNI tacrolimus	0.6	0.45-0.79	< 0.001
Retransplant	1.43	0.91-2.24	0.123
PRA	1	0.99-1.00	0.529
Cytolytic induction	0.5	0.36-0.69	< 0.001

CNI: Calcineurin inhibitor; PRA: Panel reactive antibody.

Table 4 Multivariate analysis of factors associated with graft loss

Variable	Hazard ratio	95%CI	P-value
CNI tacrolimus	0.74	0.58-0.94	0.012
History of DM	1.41	1.13-1.76	0.002
History of HTN	0.56	0.34-0.94	0.029
Delayed graft function	2.1	1.66-2.66	< 0.001
Acute rejection	1.59	1.26-2.01	< 0.001

CNI: Calcineurin inhibitor; DM: Diabetes mellitus; HTN: Hypertension.

Table 5 Graft loss n (%)

Parameter	Tacrolimus n = 106	Cyclosporine n = 123	P-value
Death with functioning graft	61 (58)	66 (54)	0.55
Cause of death			0.85
Cardiovascular disease	19 (18)	19 (15)
Infections	10 (9)	9 (7)
Malignancy	10 (9)	9 (7)
Others	33 (31)	41 (33)
Causes of graft loss			0.44
Chronic allograft nephropathy	18 (17)	29 (24)
Acute rejection	14 (13)	11 (9)
Acute on chronic rejection	8 (8)	13 (11)
Recurrent disease	1 (1)	1 (1)
Death	63 (59)	68 (55)
Component of non- adherence	15 (14)	20 (16)	0.65
Component of underimmunosuppression	21 (20)	25 (20)	0.92