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Renal function outcomes in kidney transplant recipients after conversion to everolimus-based immunosuppression
A Cataneo-Dávila1, J Zúñiga-Varga, R Correa-Rotter
1Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.
Background:
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.
Objective:
To evaluate the effect of conversion from CNIs to everolimus in kidney transplant recipients with CAN.
Patients And Methods:
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 Mycophenolate mofetil or azathioprine were withdrawn in group 1, whereas both agents were maintained in group 2.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.
Results:
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.
Conclusions:
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.
Insights
Switching kidney transplant patients with chronic allograft nephropathy from calcineurin inhibitors to everolimus may help preserve kidney function. This pilot study showed stable renal function after conversion, suggesting a potential benefit for managing this condition.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation
Background:
- Chronic allograft nephropathy (CAN) is a leading cause of kidney transplant failure.
- Calcineurin inhibitor (CNI) toxicity is a contributing factor to CAN.
- Effective management strategies for CAN are crucial for long-term graft survival.
Purpose of the Study:
- To assess the impact of converting from CNIs to everolimus in kidney transplant recipients diagnosed with CAN.
- To evaluate the safety and efficacy of an everolimus-based immunosuppression regimen in this patient population.
Main Methods:
- A 12-month pilot study involving renal transplant recipients with biopsy-proven CAN.
- Patients were switched to an everolimus-based regimen, with CNI dosage reduced or discontinued.
- Immunosuppression was adjusted, with mycophenolate mofetil or azathioprine modified or maintained, and all patients received prednisone.
Main Results:
- Twenty patients were transitioned to everolimus; renal function remained stable post-conversion (serum creatinine and eGFR showed no significant changes).
- One patient experienced acute rejection (Banff grade Ib), and three patients had borderline changes, all with low everolimus levels (<3 ng/mL).
Conclusions:
- Reducing or withdrawing CNIs and initiating everolimus may help slow renal function decline in patients with CAN.
- This conversion strategy appears to maintain renal function in the short term, warranting further investigation.
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