{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:32:45Z","timestamp":1753893165473,"version":"3.41.2"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T00:00:00Z","timestamp":1697414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The combination of tacrolimus\/mTORi compared to tacrolimus\/mycophenolate (MMF) was shown to be safe in the TRANSFORM trial. For donors with a high KDPI (Kidney Donor Profile Index), however, there are no data to support the effectiveness of this regimen. The main objective of this study was to explore the influence of the KDPI on 12-month renal function (eGFR) in patients receiving mTORi or MMF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Multicenter cohort study of four Brazilian services that use the tacrolimus with mTORi as a protocol. Data from 2008 to 2018 of the tacrolimus\/mycophenolate (MMF) and tacrolimus\/mTORi (mTORi) regimens in renal transplant recipients over 18 years old were collected. For better homogeneity, the propensity score was used. Afterward, the method used for group selection (\u201cmatch\u201d) was the K-nearest neighbor (KNN) method. New analyses were performed on this new balanced sample, and two different subsamples were constituted based on the median KDPI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The global analysis (<jats:italic>n<\/jats:italic>\u2009=\u2009870) showed that the major determinant of worse kidney function was high KDPI. Afterward, the three strata were analyzed. In the first stratum (KDPI up to 50), 242 patients were evaluated, with 121 in each group. The eGFR was 64\u2005ml\/min\/1.73\u2005m2 in the mTORi group compared to 63 in the MMF group, <jats:italic>p<\/jats:italic>\u2009=\u20090.4, and when imputed eGFR was evaluated, 61 in the mTORi and 53 in the MMF, <jats:italic>p<\/jats:italic>\u2009=\u20090.065. In the second stratum (KDPI from 50 to 85), 282 patients were evaluated, with 141 in each group. eGFR was 46\u2005ml\/min\/1.73\u2005m2 in mTORi compared to 48 in MMF, <jats:italic>p<\/jats:italic>\u2009=\u20090.4, and when imputed eGFR was evaluated, 40 mTORi and 41 MMF, <jats:italic>p<\/jats:italic>\u2009=\u20090.8. In the last stratum (KDPI higher than 85) with <jats:italic>n<\/jats:italic>\u2009=\u2009126 and 63 cases per group, eGFR was 36\u2005ml\/min\/1.73\u2005m2 in mTORi compared to 39 in MMF, <jats:italic>p<\/jats:italic>\u2009=\u20090.2, and when imputed eGFR was evaluated, 30 mTORi and 34 MMF, <jats:italic>p<\/jats:italic>\u2009=\u20090.2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The regimen using mTOR inhibitor is an effective and safe regimen when compared to the standard regimen. In addition, the scheme seems to offer additional protection against infections and may be an important ally in cases of high risk for these pathologies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frtra.2023.1279940","type":"journal-article","created":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T05:38:14Z","timestamp":1697434694000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Renal function at 12 months of kidney transplantation comparing tacrolimus and mycophenolate with tacrolimus and mTORi in donors with different KDPI ranges. A multicenter cohort study using propensity scoring"],"prefix":"10.3389","volume":"2","author":[{"given":"Arlisson Macedo","family":"Rodrigues","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana Tavares","family":"Tanno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana Moraes","family":"Contti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong Si","family":"Nga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana Farina","family":"Valiatti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvana Daher","family":"Costa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tain\u00e1 Veras de","family":"Sandes-Freitas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronaldo de Matos","family":"Esmeraldo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camila Marinho","family":"Assun\u00e7\u00e3o","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana Bastos Campos","family":"Tassi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo Fernandes","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia Rosso","family":"Felipe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Osmar","family":"Medina Pestana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helio Tedesco","family":"Silva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Gustavo Modelli de","family":"Andrade","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1111\/j.1600-6143.2010.03043.x","article-title":"Geographic variation in end-stage renal disease incidence and access to deceased donor kidney transplantation","volume":"10","author":"Mathur","year":"2010","journal-title":"Am J Transplant"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2382","DOI":"10.1093\/ndt\/gfq826","article-title":"Deceased donor transplantation in the elderly\u2013are we creating false hope?","volume":"26","author":"Stevens","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"B3","doi-asserted-by":"publisher","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 Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2519","DOI":"10.1056\/NEJMoa067411","article-title":"Reduced exposure to calcineurin inhibitors in renal transplantation","volume":"358","author":"Van den Hoogen","year":"2008","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1097\/TP.0b013e3182848e03","article-title":"Randomized trial of everolimus-facilitated calcineurin inhibitor minimization over 24 months in renal transplantation","volume":"95","author":"Cibrik","year":"2013","journal-title":"Transplant J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1111\/j.1432-2277.2012.01465.x","article-title":"Everolimus plus early tacrolimus minimization: a phase III, randomized, open-label, multicentre trial in renal transplantation","volume":"25","author":"Langer","year":"2012","journal-title":"Transpl Int"},{"key":"B7","doi-asserted-by":"publisher","first-page":"45","DOI":"10.2147\/OAJCT.S63058","article-title":"TRANSFORM: a novel study design to evaluate the effect of everolimus on long-term outcomes after kidney transplantation","volume":"6","author":"Pascual","year":"2014","journal-title":"J Clin Trials"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2655","DOI":"10.1111\/ajt.13327","article-title":"Reduced incidence of cytomegalovirus infection in kidney transplant recipients receiving everolimus and reduced tacrolimus doses","volume":"15","author":"Tedesco-Silva","year":"2015","journal-title":"Am J Transplant"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1097\/TP.0b013e3182708e56","article-title":"Is cytomegalovirus prophylaxis dispensable in patients receiving an mTOR inhibitor\u2013based immunosuppression? 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