학술논문
Long-term outcomes in African American kidney transplant recipients under contemporary immunosuppression: a four-yr analysis of the Mycophenolic acid Observational REnal transplant (MORE) study.
Document Type
Article
Author
Source
Subject
*KIDNEY transplant patients
*HEALTH outcome assessment
*IMMUNOSUPPRESSION
*MYCOPHENOLIC acid
*TACROLIMUS
*ADRENOCORTICAL hormones
*DRUG dosage
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Language
ISSN
0902-0063
Abstract
Mycophenolic acid Observational REnal transplant ( MORE) was a prospective, observational study of de novo kidney transplant patients receiving mycophenolic acid ( MPA). Four-yr data on 904 patients receiving tacrolimus and enteric-coated mycophenolate sodium ( EC- MPS) or mycophenolate mofetil ( MMF) were analyzed to evaluate immunosuppression and graft outcomes in African American ( AA, n = 218) vs. non- AA (n = 686) patients. Mean tacrolimus dose was higher in AA vs. non- AA patients but mean tacrolimus trough concentration was similar. Use of the recommended MPA dose in AA patients decreased from 78.9% at baseline to 33.1% at year 3. More AA patients received the recommended MPA dose with EC- MPS than MMF at month 6 (56.2% vs. 35.7%, p = 0.016) and month 36 (46.6% vs. 16.7%, p = 0.029), with no safety penalty. Significantly, more AA patients received corticosteroids than non- AA patients. Biopsy-proven acute rejection was higher in AA vs. non- AA patients (18.9% vs. 10.7%, p = 0.003), as was graft loss (10.9% vs. 4.4%, p = 0.003); differences were confirmed by Cox regression analysis. Patient survival was similar. Estimated GFR was comparable in AA vs. non- AA patients. Kidney allograft survival remains lower for AA vs. non- AA recipients even under the current standard of care. [ABSTRACT FROM AUTHOR]