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Conversion to everolimus in liver transplant patients with renal dysfunction
1Liver and Gastroenterology Unit, Hospital San Borja-Arriarán, University of Chile, Medical School, Santiago, Chile.
Transplantation Proceedings
|August 16, 2011
Summary
Switching liver transplant patients with renal dysfunction from calcineurin inhibitors (CNI) to everolimus (EVE) significantly improved kidney function. This conversion maintained graft survival without rejection, offering a safer immunosuppressive strategy.
Area of Science:
- Nephrology
- Hepatology
- Pharmacology
Background:
- Calcineurin inhibitors (CNI) are crucial for preventing graft rejection after liver transplantation (OLT).
- CNI therapy is associated with significant nephrotoxicity, leading to renal dysfunction (RDF).
- Mammalian target of rapamycin (mTOR) inhibitors offer a nonnephrotoxic alternative for immunosuppression.
Purpose of the Study:
- To evaluate renal function in liver transplant recipients experiencing RDF.
- To assess the efficacy of switching from CNI to an mTOR inhibitor (everolimus) in improving renal function.
- To determine if this switch impacts graft rejection rates.
Main Methods:
- Prospective study of liver transplant patients from 2000 to 2009.
- Patients with RDF were converted fully or partially to everolimus (EVE).
- Creatinine levels and creatinine clearances (Cockroft-Gault) were measured pre- and post-conversion; Wilcoxon nonparametric tests were used for comparison.
Main Results:
- Six patients were converted to EVE, with a mean follow-up of 25.8 months.
- Significant improvement in renal function was observed post-conversion (P = .03).
- Mean creatinine levels decreased from 2.26 to 1.21 mg/dL, and glomerular filtration rate increased from 40 to 72.60 mL/min/m(2).
Conclusions:
- Conversion from CNI to everolimus effectively improves renal function in liver transplant patients with RDF.
- This therapeutic switch is associated with long-term graft survival free of rejection episodes.
- Everolimus represents a viable, kidney-sparing immunosuppressive option post-OLT.
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