{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T18:59:33Z","timestamp":1773687573914,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,5,12]],"date-time":"2018-05-12T00:00:00Z","timestamp":1526083200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2018,6]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>We sought to determine whether conversion from tacrolimus\/mycophenolate mofetil (TAC<\/jats:styled-content>\u2010MMF<\/jats:styled-content>) into tacrolimus\/mTOR<\/jats:styled-content> inhibitor (TAC<\/jats:styled-content>\u2010mTOR<\/jats:styled-content>) immunosuppression would reduce the incidences of BK<\/jats:styled-content> and CMV<\/jats:styled-content> viremia after kidney\/pancreas (KP<\/jats:styled-content>) transplantation.<\/jats:p><\/jats:sec>Methods<\/jats:title>In this single\u2010center review, the TAC<\/jats:styled-content>\u2010mTOR<\/jats:styled-content> cohort (n\u00a0=\u00a039) was converted at 1\u00a0month post\u2010transplant to an mTOR<\/jats:styled-content> inhibitor and reduced\u2010dose tacrolimus. Outcomes were compared to a cohort of KP<\/jats:styled-content> recipients (n\u00a0=\u00a040) maintained on TAC<\/jats:styled-content>\u2010MMF.<\/jats:p><\/jats:sec>Results<\/jats:title>At 3\u00a0years post\u2010transplant, KP<\/jats:styled-content> survivals and incidences of kidney\/pancreas rejection were equivalent between mTOR<\/jats:styled-content> and MMF<\/jats:styled-content>\u2010treated cohorts. (P<\/jats:italic>\u00a0=\u00a0ns). BK<\/jats:styled-content> viremia\u2010free survival was better for the mTOR<\/jats:styled-content> vs MMF<\/jats:styled-content>\u2010treated group (P<\/jats:italic>\u00a0=\u00a0.004). In multivariate analysis, MMF<\/jats:styled-content> vs mTOR<\/jats:styled-content> immunosuppression was an independent risk factor for BK<\/jats:styled-content> viremia (hazard ratio 12.27, P<\/jats:italic>\u00a0=\u00a0.02). Similarly, mTOR<\/jats:styled-content>\u2010treated recipients displayed better CMV<\/jats:styled-content> infection\u2010free survival compared to the MMF<\/jats:styled-content>\u2010treated cohort (P<\/jats:italic>\u00a0=\u00a0.01). MMF<\/jats:styled-content> vs mTOR<\/jats:styled-content> immunosuppression (hazard ratio 18.77, P<\/jats:italic>\u00a0=\u00a0.001) and older recipient age (hazard ratio 1.13 per year, P<\/jats:italic>\u00a0=\u00a0.006) were independent risk factors for CMV<\/jats:styled-content> viremia. Mean estimated GFR<\/jats:styled-content> and HgbA1c levels were equivalent between groups at 1, 2, and 3\u00a0years post\u2010transplantation.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Conversion from TAC<\/jats:styled-content>\/MMF<\/jats:styled-content> into TAC<\/jats:styled-content>\/mTOR<\/jats:styled-content> immunosuppression after KP<\/jats:styled-content> transplantation reduced the incidences of BK<\/jats:styled-content> and CMV<\/jats:styled-content> viremia with an equivalent risk of acute rejection and similar renal\/pancreas function.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.13265","type":"journal-article","created":{"date-parts":[[2018,4,20]],"date-time":"2018-04-20T01:32:11Z","timestamp":1524187931000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Conversion from tacrolimus\u2010mycophenolate mofetil to tacrolimus\u2010mTOR<\/scp> immunosuppression after kidney\u2010pancreas transplantation reduces the incidence of both BK<\/scp> and CMV<\/scp> viremia"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0870-629X","authenticated-orcid":false,"given":"Richard J.","family":"Knight","sequence":"first","affiliation":[{"name":"Department of Surgery Houston Methodist Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward A.","family":"Graviss","sequence":"additional","affiliation":[{"name":"Department of Pathology and Genomic Medicine Houston Methodist Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duc T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Pathology and Genomic Medicine Houston Methodist Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha A.","family":"Kuten","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samir J.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian","family":"Gaber","sequence":"additional","affiliation":[{"name":"Department of Pathology and Genomic Medicine Houston Methodist Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Osama","family":"Gaber","sequence":"additional","affiliation":[{"name":"Department of Surgery Houston Methodist Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,5,12]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"2012 Annual Report of the U.S.Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1994\u20102003. Department of Health and Human Services Health Resources and Services Administration Healthcare Systems Bureau Division of Transplantation Rockville MD; United Network for Organ Sharing Richmond VA; University Renal Research and Education Association Ann Arbor MI."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.12655"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200112270-00013"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv441"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13327"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13649"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14090"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.12151"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13541"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2006.01688.x"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03670.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.17.2038"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.13221216"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2012.04235.x"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.12381"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2010.05.121"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000287117.98785.54"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181c9dc9b"},{"key":"e_1_2_6_20_1","first-page":"940","article-title":"Impact of tacrolimus\u2010sirolimus maintenance immunosuppression on proteinuria and kidney function in pancreas transplant alone recipients","volume":"15","author":"Kadnula P","year":"2012","journal-title":"Transplantation"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2014.06.010"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-6143.2003.00185.x"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000164352.65613.24"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2012.04320.x"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31826690c6"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fctr.13265","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.13265","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T00:38:05Z","timestamp":1695429485000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.13265"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,12]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1111\/ctr.13265"],"URL":"https:\/\/doi.org\/10.1111\/ctr.13265","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,12]]},"assertion":[{"value":"2018-04-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13265"}}