Inhibitors of mTOR and Risks of Allograft Failure and Mortality in Kidney Transplantation

摘要: Data on long-term outcomes of users inhibitors the mammalian target rapamycin (mTORI) are lacking in kidney transplantation. In an analysis 139 370 US transplant recipients between 1999 through 2010, we compared clinical among mTORIs versus calcineurin (CNI) their primary immunosuppresive regimen. During first 2 years posttransplantation, use without CNIs (N = 3237) was associated with greater risks allograft failure and death a CNI-based regimen 125 623); hazard ratio (HR) composite outcome ranged from 3.67 (95% confidence interval [CI], 3.12-4.32) after discharge to 1.40 CI 1.26-1.57) by year 2. 2-8, independently (HR 1.25; 95% CI, 1.11-1.41) 1.17; 95%CI, 1.08-1.27) fully adjusted analyses. The results were qualitatively unchanged subgroups defined medical history, immunological risk course during index hospitalization. propensity-score matched cohort, significantly worse 1.21; 1.05-1.39) 1.18; 1.08-1.30) 2-8. Compared regimens, mTORI-based for immunosuppression transplantation inferior recipient survival.