Simulect induction facilitates neoral-based steroid-free immunosuppression in primary kidney transplant recipients

This study compares outcomes of kidney transplantation with two distinct induction protocols Basiliximab (Simulect) versus Muromonab (OTK 3) in the setting of cyclosporine (Neoral)-based immunosuppression. Postinduction protocols included either total prednisone avoidance or prednisone sparing versus standard prednisone dosing. Two hundred forty five adult patients receiving kidney transplantation between 1995 and 2000 were included in the study. Treatment in group 1 was OKT 3 + Neoral + adjunct + standard prednisone; group 2, Simulect + Neoral + adjunct + steroid sparing; group 3, Simulect + Neoral + adjunct + no prednisone. The demographics between all groups were similar. The mean (±SD) trough cyclosporine levels at 1 month were 276 ± 128 versus 291 ± 180 versus 398 ± 365 ( P = .020); at 3 months were 261 ± 120 versus 280 ± 152 versus 399 ± 408 ( P = .32); at 12 month were 235 ± 144 versus 245 ± 154 versus 234 ± 132 ( P = .96). Creatinine clearance at 1 month was 59 ± 24 versus 58 ± 18 versus 47 ± 23 mL/min ( P = .004); at 3 months was 66 ± 28 versus 62 ± 22 versus 53 ± 25 mL/min ( P = .007); at 12 months was 68 ± 38 versus 65 ± 22 versus 64 ± 29 mL/min ( P = .556). Serum creatinine at 1 month was 1.8 ± 0.9 versus 1.6 ± 1.2 versus 2.8 ± 2.21 mg/dL ( P = .005); at 3 months was 1.7 ± 0.6 versus 1.9 ± 1.0 versus 2.3 ± 1.3 mg/dL ( P = .007); at 12 months was 1.9 ± 1.3 versus 2.1 ± 1.0 versus 2.3 ± 1.7 mg/dL ( P = .179). The incidence of acute rejection within 1 year in the respective groups were 28% versus 15% versus 16%. Therefore, we conclude that using Simulect in transplant recipients results in long-term patient and graft survival similar to those achieved with OKT 3. The use of Simulect resulted in significant reduction in clinical rejection incidence within the first year regardless of steroid use. Thus, the use of Simulect allows complete steroid avoidance in Neoral-based immunosuppression regimen.