KIDNEY transplant recipients showed comparable patient survival, graft survival and acute rejection outcomes across immunosuppressive regimens, regardless of recipient age, according to a retrospective cohort study.
Researchers analysed data from the Scientific Registry of Transplant Recipients, categorising recipients into two age groups: 18–64 years and >65 years. The study compared four maintenance immunosuppressive regimens: tacrolimus/mycophenolate mofetil (Tac-MMF), tacrolimus/mammalian target of rapamycin inhibitor (Tac-mTORi), cyclosporin/mycophenolate mofetil and mammalian target of rapamycin inhibitor/mycophenolate mofetil.
The primary endpoint was overall survival. The analysis included 112,952 kidney transplant recipients, with overall survival at 2, 3 and 5 years of 95.6%, 93.7% and 87.6%, respectively.
No significant differences were identified in mortality, graft loss or acute rejection between recipients receiving Tac-mTORi and those receiving Tac-MMF. The researchers also found no significant interaction between immunosuppressive regimen and age group for these outcomes.
However, differences emerged with regard to kidney function. Among younger recipients, those receiving Tac-mTORi had a lower mean estimated glomerular filtration rate (eGFR) throughout follow-up compared with recipients receiving Tac-MMF.
This pattern was not observed among older recipients. Patients aged >65 years who received Tac-mTORi did not experience a significant additional decline in renal function compared with those receiving Tac-MMF.
The findings suggested that age did not substantially modify the association between the assessed immunosuppressive regimens and major clinical outcomes, although renal function differed between treatment groups in younger recipients.
The findings indicated that Tac-mTORi and Tac-MMF produced comparable results for patient survival, graft survival and rejection rates across the analysed age groups.
Despite these similarities, the study highlighted the importance of individualising immunosuppressive regimens for older kidney transplant recipients. This population remained at higher risk of treatment-related adverse effects, including infections, metabolic disorders and malignancies.
The researchers therefore emphasised the need for individually tailored treatment approaches in older recipients. They also called for prospective studies to validate the observed findings and further clarify how age and immunosuppressive regimens may influence outcomes after kidney transplantation.
Serna-Higuita LM et al. Age-specific impact of different immunosuppressive regimens on kidney transplant outcomes: clinical evidence from the scientific registry of transplant recipients. Front. Nephrol. 2026;6:1886887.
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