Introduction: The efficacy of extended release tacrolimus (TACER) and everolimus (EVR) in kidney transplantation have been demonstrated independently. However, there is few reports on the efficacy of extended release tacrolimus and everolimus based immunosuppressive regimen in KT. We investigated the impact of TACER and EVR based immunosuppressive (IS) regimen on living donor kidney transplantation (LDKT).

Methods: A total 160 recipients underwent LDKT were included in this study. Steroids, TACER and mycophenolate mofetil (MMF) based IS regimen was administered in 77 recipeints (MMF group). Steroids, TACER and EVR based IS regimen was administered in 83 recipients (EVR group). The primary outcomes were the estimated glomerular filtration rate (eGFR), de novo donor specific antibody (DSA), rejection, graft survival, and recipient survival. The secondary outcome was the findings of calcineurin inhibitor (CNI) toxicity by the protocol biopsy at 1 month and 12 months after LDKT and incidences of cytomegalovirus infection and all infectious diseases requring treatment. Inverse probability of treatment weighting analysis was used.

Results: The eGFR changes over time, de novo DSA free survival rate (P=0.413), rejection free survival rate (P=0.385), graft loss free survival rate (0.692), and recipient survival rate (0.570) were similar between 2 groups. the findings of calcineurin inhibitor (CNI) toxicity by the protocol biopsy at 1 month and 12 months after LDKT were more frequent in the EVR group (P=0.059 and P=0.006). Incidences of cytomegalovirus infection (P=0.896) and all infectious diseases requring treatment (P=0.524) were similar between 2 groups.

Conclusion: The efficacy of TACER and EVR based IS regimen was similar to that of TACER and MMF based IS regimen except for frequent findings of CNI toxicity.