Renal Function Outcomes in Kidney Transplant Recipients After Conversion to Everolimus-Based Immunosuppression Regimen with CNI Reduction or Elimination
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Abstract
Chronic allograft nephropathy (CAN) is a major cause of progressive renal failure
in kidney transplant recipients. Its etiology is multifactorial and can be due to
immunologic or nonimmunologic conditions including calcineurin inhibitor (CNI) toxicity.
To evaluate the effect of conversion from CNIs to everolimus in kidney transplant
recipients with CAN.
In this 12-month pilot study in renal transplant recipients with biopsy-proved CAN,
therapy was changed to an everolimus-based immunosuppression regimen. Cyclosporine
or tacrolimus dosage was reduced by 80% (group 1, n = 10) or discontinued (group 2,
n = 10). Mycophenolate mofetil or azathioprine were withdrawn in group 1, whereas
both agents were maintained in group 2. All patients received prednisone.
Twenty renal allograft recipients switched to an everolimus-based regimen, and patients
were followed up for a mean (SD) of 12 (0.1) months. Baseline and end-of-study data
were as follows: serum creatinine concentration, 1.27 (0.35) mg/dL vs 1.24 (0.4) mg/dL
in group 1, and 1.27 mg/dL (0.36) vs 1.25 (0.3) mg/dL in group 2 (difference not significant);
and estimated glomerular filtration rate, 72.4 (19.86) mL/min vs 76.26 (22.69) mL/min
in group 1 (not significant), and 66.2 (12.95) mL/min vs 66.2 (13.73) mL/min in group
2 (not significant). One patient in group 1 experienced an acute rejection episode
(Banff grade Ib), and 2 patients in group 1 and 1 patient in group 2 demonstrated
borderline changes, all associated with everolimus blood concentration less than 3
ng/mL.
Reduction or withdrawal of CNI and introduction of everolimus may be useful to slow
the rate of loss of renal function in patients with CAN.