Kidney Week

Abstract: PUB081

Improving Evidence-Based Use of Calcineurin Inhibitor (CNI)-Sparing Immunosuppression After Kidney Transplantation: Development and Implementation of a New Clinical Resource

Session Information

• Publication Only

Category: Educational Research

• 1000 Educational Research

Authors

• Vincenti, Flavio, University of California San Francisco, San Francisco, California, United States

Flavio Vincenti, MD

• Wojciechowski, David, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

David Wojciechowski, DO

• Miklich, Margaret A., PRIME Education LLC, New York, New York, United States

Margaret A. Miklich, PharmD

• Zyborowicz, Emily, PRIME Education LLC, New York, New York, United States

Emily Zyborowicz, MPH

• Maytorena, Jacqueline, PRIME Education LLC, New York, New York, United States

Jacqueline Maytorena, MPH

• Carter, Jeffrey D., PRIME Education LLC, New York, New York, United States

Jeffrey D. Carter, PhD

• Molloy, Leah, PRIME Education LLC, New York, New York, United States

Leah Molloy, PharmD

• Simone, Laura, PRIME Education LLC, New York, New York, United States

Laura Simone, PhD

• Balmer, Jennifer, PRIME Education LLC, New York, New York, United States

Jennifer Balmer, PhD

Background

While calcineurin inhibitors (CNIs) have reduced acute rejection rates after kidney transplantation, long-term efficacy is limited by toxicities that compromise graft and patient survival. CNI-sparing regimens may improve long-term outcomes in selected patients, however, adoption remains limited by lack of updated guidance and standardized protocols. This initiative aimed to improve utilization of CNI-sparing regimens through implementation of a practical, expert-guided clinical resource.

Methods

A resource synthesizing contemporary evidence and best practices for CNI-sparing regimens was developed with a panel of clinical experts in renal transplantation. The resource comprised evidence summaries, practical tools, and example protocols to support patient selection, monitoring, and conversion. Between September-December 2025, clinicians (n=95) from 5 US academic transplant centers participated in educational sessions reviewing CNI-sparing strategies and resource tools. Baseline and 90-day follow-up surveys evaluated self-reported practice change.

Results

At baseline, 80% of clinicians agreed CNI-sparing regimens can improve long-term graft outcomes; however, fewer than half reported high confidence in identifying candidates (44%), routinely evaluating patients for CNI-sparing approaches (46%), or having protocols aligned with the latest evidence (47%). The resource was most commonly used as a clinical reference (64%), for team education (32%), and/or integrated into workflows (23%). Following the intervention, confidence in candidate selection (71%, p<.001) and routine evaluation for CNI-sparing regimens (77%, p=.008) increased. Likelihood of considering CNI-sparing regimens increased for patients with cardiovascular or metabolic complications (29% vs 50%, p=.067) and high-KDPI kidney recipients (23% vs 55%, p=.004). Overall, 82% reported increased likelihood of initiating or converting to CNI-sparing regimens when clinically appropriate. Agreement that institutional protocols aligned with the latest evidence also improved (68%, p=.021).

Conclusion

An expert-informed clinical resource combined with targeted education improved clinician confidence and self-reported use of CNI-sparing strategies, suggesting a role for such approaches in bridging gaps in standardized guidance and translating new evidence into practice.

Funding

• Commercial Support – The study reported in this abstract was supported by an educational grant from Bristol Myers Squibb. The grantor had no role in the study design, execution, analysis, or reporting.