Reduced-intensity immunosuppression in older kidney transplant recipients

Results from a single-center, retrospective study, evaluating immunosuppressive regimens in older kidney transplant recipients (KTRs), were published in the Brazilian Journal of Nephrology by Alcântara et al. Dosing of immunosuppressive therapies during the first year post-transplantation was compared between older KTRs (≥60 years; n = 59) and younger controls (30–50 years; n = 114).

Key data: Compared with younger controls, older KTRs received lower mycophenolate doses (11 ± 7.7 vs 15 ± 7.2 mg/kg/day; p = 0.003) and were less likely to receive corticosteroids as maintenance therapy (18.6% vs 64.9%; p = 0.0001). Despite lower tacrolimus doses, older KTRs had a higher tacrolimus level-to-dose ratio (p < 0.05). Adverse events (AEs) were more frequent in older KTRs, including leukopenia (56.5% vs 35.6%; p = 0.017) and cytomegalovirus infection (44.7% vs 26.9%; p = 0.034). One-year overall survival (OS) was lower in older KTRs (86.4% vs 95.6%; p = 0.014), while graft survival was comparable between groups (86.8% vs 92.7%; p = 0.780)

Key learning: Reduced-intensity immunosuppression in older KTRs was associated with comparable short-term graft survival but higher rates of AEs and lower OS, supporting an individualized approach to immunosuppressive dosing in this population.