Long-Term Clinical Outcomes and Dynamics of Immunosuppressive Therapy in Kidney Transplant Recipients in Uzbekistan: A Retrospective Study.

Abstract

Objectives: This study evaluated the long -term clinical outcomes and dynamics of immunosuppressive therapy in kidney transplant recipients in Uzbekistan, which was compared with international data.

Materials and methods: This retrospective multicenter cohort study included 3437 kidney transplant recipients. Data were obtained from the national transplant registry. Follow -up ranged from 1 to 30 years. Clinical outcomes, graft survival, recipient survival, and immunosuppressive therapy parameters were analyzed. Repeated -measures analysis of variance and life -table analysis were used for statistical evaluation.

Results: A gradual reduction in tacrolimus dose was observed from 6.68 mg /day at year 1 to 5.58 mg /day at year 10, accompanied by a decrease in mean blood concentration from 8.28 to 6.55 ng /mL. Mycophenolate mofetil dosing decreased significantly over time (P < .001 ), whereas mycophenolic acid dosing remained stable (P > .05 ). The incidence of graft loss requiring return to hemodialysis was 2.88 %. A biphasic pattern of graft loss was identified, with peaks within the first 3 years and after 10 years posttransplant. Recipient survival rates were 98.8 % at 1 year and 96.9 % at 10 years.

Conclusions: Kidney transplantation in Uzbekistan demonstrates favorable long -term outcomes comparable to international benchmarks. Immunosuppressive therapy shows a trend toward controlled minimization. The identified biphasic risk of graft loss highlights the importance of long -term monitoring and individualized management strategies.