{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T14:15:56Z","timestamp":1777644956582,"version":"3.51.4"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2018,12,16]],"date-time":"2018-12-16T00:00:00Z","timestamp":1544918400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100002997","name":"Dutch Kidney Foundation","doi-asserted-by":"publisher","award":["CP12.23"],"award-info":[{"award-number":["CP12.23"]}],"id":[{"id":"10.13039\/501100002997","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Few studies have evaluated the effect of different immunosuppressive strategies on long-term kidney transplant outcomes. Moreover, as they were usually based on historical data, it was not possible to account for the presence of pretransplant donor-specific human-leukocyte antigen antibodies (DSA), a currently recognized risk marker for impaired graft survival. The aim of this study was to evaluate to what extent frequently used initial immunosuppressive therapies increase graft survival in immunological low-risk patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed an analysis on the PROCARE cohort, a Dutch multicentre study including all transplantations performed in the Netherlands between 1995 and 2005 with available pretransplant serum (n\u2009=\u20094724). All sera were assessed for the presence of DSA by a luminex single-antigen bead assay. Patients with a previous kidney transplantation, pretransplant DSA or receiving induction therapy were excluded from the analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Three regimes were used in over 200 patients: cyclosporine (CsA)\/prednisolone (Pred) (n\u2009=\u2009542), CsA\/mycophenolate mofetil (MMF)\/Pred (n\u2009=\u2009857) and tacrolimus (TAC)\/MMF\/Pred (n\u2009=\u2009811). Covariate-adjusted analysis revealed no significant differences in 10-year death-censored graft survival between patients on TAC\/MMF\/Pred therapy (79%) compared with patients on CsA\/MMF\/Pred (82%, P\u2009=\u20090.88) or CsA\/Pred (79%, P\u2009=\u20090.21). However, 1-year rejection-free survival censored for death and failure unrelated to rejection was significantly higher for TAC\/MMF\/Pred (81%) when compared with CsA\/MMF\/Pred (67%, P\u2009&lt;\u20090.0001) and CsA\/Pred (64%, P\u2009&lt;\u20090.0001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>These results suggest that in immunological low-risk patients excellent long-term kidney graft survival can be achieved irrespective of the type of initial immunosuppressive therapy (CsA or TAC; with or without MMF), despite differences in 1-year rejection-free survival.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ndt\/gfy377","type":"journal-article","created":{"date-parts":[[2018,12,5]],"date-time":"2018-12-05T15:12:15Z","timestamp":1544022735000},"page":"1417-1422","source":"Crossref","is-referenced-by-count":9,"title":["Effect of initial immunosuppression on long-term kidney transplant outcome in immunological low-risk patients"],"prefix":"10.1093","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0382-143X","authenticated-orcid":false,"given":"Laura A","family":"Michielsen","sequence":"first","affiliation":[{"name":"Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjan D","family":"van Zuilen","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne C","family":"Verhaar","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bram W","family":"Wisse","sequence":"additional","affiliation":[{"name":"Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena G","family":"Kamburova","sequence":"additional","affiliation":[{"name":"Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irma","family":"Joosten","sequence":"additional","affiliation":[{"name":"Laboratory Medicine, Lab. Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wil A","family":"Allebes","sequence":"additional","affiliation":[{"name":"Laboratory Medicine, Lab. Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnold","family":"van der Meer","sequence":"additional","affiliation":[{"name":"Laboratory Medicine, Lab. Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marije C","family":"Baas","sequence":"additional","affiliation":[{"name":"Radboud Institute for Health Sciences, Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Spierings","sequence":"additional","affiliation":[{"name":"Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelis E","family":"Hack","sequence":"additional","affiliation":[{"name":"Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franka E","family":"van Reekum","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiel L","family":"Bots","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriaan C A D","family":"Drop","sequence":"additional","affiliation":[{"name":"Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loes","family":"Plaisier","sequence":"additional","affiliation":[{"name":"Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc A J","family":"Seelen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan-Stephan F","family":"Sanders","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bouke G","family":"Hepkema","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annechien J","family":"Lambeck","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura B","family":"Bungener","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Roozendaal","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcel G J","family":"Tilanus","sequence":"additional","affiliation":[{"name":"Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christien E","family":"Voorter","sequence":"additional","affiliation":[{"name":"Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lotte","family":"Wieten","sequence":"additional","affiliation":[{"name":"Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth M","family":"van Duijnhoven","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mari\u00eblle A C J","family":"Gelens","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maarten H L","family":"Christiaans","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frans J","family":"van Ittersum","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaikh A","family":"Nurmohamed","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neubury M","family":"Lardy","sequence":"additional","affiliation":[{"name":"Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Swelsen","sequence":"additional","affiliation":[{"name":"Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karlijn A","family":"van der Pant","sequence":"additional","affiliation":[{"name":"Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neelke C","family":"van der Weerd","sequence":"additional","affiliation":[{"name":"Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ineke J M","family":"ten Berge","sequence":"additional","affiliation":[{"name":"Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederike J","family":"Bemelman","sequence":"additional","affiliation":[{"name":"Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andries","family":"Hoitsma","sequence":"additional","affiliation":[{"name":"Dutch Organ Transplant Registry (NOTR), Dutch Transplant Foundation (NTS), Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul J M","family":"van der Boog","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan W","family":"de Fijter","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Leiden University Medical Center, Leiden, The 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Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henderikus G","family":"Otten","sequence":"additional","affiliation":[{"name":"Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luuk B","family":"Hilbrands","sequence":"additional","affiliation":[{"name":"Radboud Institute for Health Sciences, Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,12,15]]},"reference":[{"key":"2019080503544580600_gfy377-B1","doi-asserted-by":"crossref","first-page":"2715","DOI":"10.1056\/NEJMra033540","article-title":"Immunosuppressive drugs for kidney transplantation","volume":"351","author":"Halloran","year":"2004","journal-title":"N Engl J 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