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Clinical Advantages Including Medication Adherence with Conversion to Once-Daily Advagraf and Sirolimus Combination in Stable Kidney Recipients

Cheol Woong Jung

With advances in transplantation immunology and immunosuppressant, long-term outcomes had improved in kidney transplantation [1]. However, for the past decades, the long-term results of renal allograft have not changed [2]. The long-term use of a calcineurin-inhibitor (CNI) and medication non-adherence are important factors that can affect the long-term results [3,4]. Therefore, decreasing exposure of CNI and the adherence of patients to their respective immunosuppressant regimens have become more significant. Medications for kidney recipients are very complicated, and the dosage often changes and many patients often forget to take their medicine. Medication nonadherence can cause graft failure in transplant recipients who are required to go on long-term medication use [4]. Following tacrolimus, Advagraf® (Astellas Pharma Inc., Tokyo, Japan) was developed to facilitate the formulation to use once daily. In comparison to the twice-daily formulation, Advagraf is expected to improve medical adherence [5]. Sirolimus is also once-daily formulation and has been used to minimize calcineurin-inhibitor (CNI) exposure. A reduction in the CNI showed improved renal function, improved allograft survival, and decreased allograft rejection [3]. The purpose of this study is the analysis of the clinical advantages of once-daily Advagraf and sirolimus combination by decreasing the use of CNI and improving medication adherence in stable kidney recipients.