What's the Best Cocktail for Transplants?

Prograf and CellCept may be the best for patients with new kidneys

(RxWiki News) Even if a patient gets a new kidney, it is not the end of the fight against kidney disease. That patient's body can still reject the new organ. Now, researchers know which drugs work best to stop this from happening.

Kidney disease patients who took a combination of the drugs Prograf (tacrolimus) and CellCept (mycophenolate mofetil, or MMF) after kidney transplant surgery were less likely to have a rejected kidney and other problems, compared to those who were given a different drug treatment. Patients who took Prograf and CellCept were also less likely to experience serious side effects.

"Take Prograf and CellCept after a kidney transplant."

This study - which was conducted by Giselle Guerra, M.D., and her fellow researchers at the University of Miami - is the longest randomized study yet that has looked at transplant drugs.

According to Dr. Guerra, the study shows that low doses of this Prograf and CellCept are not only safe, but also give transplant patients the best long-term outcomes. In other words, these drugs are great at protecting new kidneys from being rejected while also improving the function of those kidneys.

These findings should be especially helpful to doctors who take care of kidney transplant patients.

For their study, Dr. Guerra and colleagues looked at 150 kidney transplant patients who were given one of three common drug treatments. The first treatment plan was Prograf plus CellCept. The second treatment plant included Prograf and Rapamune (sirolimus). The third treatment plant included Gengraf/Neoral/Sandimmune/Sangcya (cyclosporine) and Rapamune.

All of the patients in the study were given another drug called Zenapax (daclizumab) right after surgery. All of them were also given steroids.

The researchers followed the patients for an average of eight years.

Tacrolimus and cyclosporine are known as calcineurin inhibitors. While these drugs can stop a kidney from being rejected, they can also be very toxic to the kidneys. For this reason, patients often get low doses of calcineurin inhibitors plus drugs like sirolimus and MMF, which do not damage the kidneys. This way, patients can get the most benefits while avoiding the more dangerous side effects.

The researchers found that the survival of transplanted kidneys was similar in all of the treatment groups. However, patients who were treated with tacrolimus and MMF had fewer acute rejections (a rejection that usually happens after the first week of transplantation) than those treated with other drugs. More specifically, only 12 percent of patients treated with tacrolimus and MMF had acute rejections, compared to 30 percent of those treated with tacrolimus and sirolimus and 28 percent of those treated with cyclosporine and sirolimus.

During the first three years, patients taking tacrolimus and MMF had better kidney function than the other groups. Patients taking tacrolimus and MFF or cyclosporine and sirolimus had a lower risk of dying with a functioning transplant, compared to patients who were taking tacrolimus and sirolimus.

Patients taking sirolimus were more likely than those not taking sirolimus to get viral infections, to stop treatment, and to need other drugs to lower cholesterol.

All of these findings are published in the Journal of the American Society of Nephrology.

Review Date: 
July 29, 2011