{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T05:52:43Z","timestamp":1761630763558},"reference-count":33,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2016,10,13]],"date-time":"2016-10-13T00:00:00Z","timestamp":1476316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite long\u2010term side effects, calcineurin inhibitors (<jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>) remain a cornerstone of immunosuppression in renal transplantation. Few trials assessed the long\u2010term outcome after early <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content> withdrawal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This intention\u2010to\u2010treat study assessed the 10\u2010year outcome of 108 patients randomly converted from a cyclosporine (CsA)\u2014mycophenolate mofetil (<jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content>)\u2014prednisone regimen to a dual therapy (CsA\u2010prednisone or <jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content>\u2010prednisone) at 3\u00a0months postgraft.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 10\u00a0years, 3.7% in the CsA group and 35.2% in the <jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content> group remained on the protocol regimen (<jats:italic>P<\/jats:italic>&lt;.001). <jats:styled-content style=\"fixed-case\">eGFR<\/jats:styled-content> was higher in the <jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content> group (64.4\u00b121 vs 49.7\u00b114.7 <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\/min\/1.73 m\u00b2, <jats:italic>P<\/jats:italic>&lt;.001), although acute rejection (12 vs 4 in the CsA group, <jats:italic>P<\/jats:italic>=.03) and Class <jats:styled-content style=\"fixed-case\">II DSA<\/jats:styled-content> incidences were increased. <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>\u2010related toxicity (<jats:italic>P<\/jats:italic>=.019) and moderate\u2010to\u2010severe <jats:styled-content style=\"fixed-case\">IF<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">TA<\/jats:styled-content> (<jats:italic>P<\/jats:italic>=.004) were higher in the CsA group. Ten\u2010year graft and patient survivals were not different. In multivariate analysis, acute rejection remained the strongest predictor of graft loss (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>=11.64, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> [5.05\u201026.79], <jats:italic>P<\/jats:italic>&lt;.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content> withdrawal largely failed due to <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content> toxicity, while CsA withdrawal led to increased graft failure due to uncontrolled acute rejection without increasing graft survival. From this study, it remains unclear which patients could benefit from limiting <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content> exposure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.12843","type":"journal-article","created":{"date-parts":[[2016,9,13]],"date-time":"2016-09-13T13:12:37Z","timestamp":1473772357000},"page":"1480-1487","source":"Crossref","is-referenced-by-count":6,"title":["Long\u2010term outcome after early cyclosporine withdrawal in kidney transplantation: ten years after"],"prefix":"10.1111","volume":"30","author":[{"given":"Nahid","family":"Tabibzadeh","sequence":"first","affiliation":[{"name":"CHU Lille \u2010 Service de N\u00e9phrologie \u2010 F\u201059000 Lille France"},{"name":"Universit\u00e9 de Lille \u2010 UMR 995, F\u201059000 Lille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois","family":"Glowacki","sequence":"additional","affiliation":[{"name":"CHU Lille \u2010 Service de N\u00e9phrologie \u2010 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