Steroid Withdrawal Using Everolimus in ABO-Incompatible Kidney Transplant Recipients With Post-Transplant Diabetes...

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• The efficacy of everolimus (EVR) in ABO-incompatible (ABOi) kidney transplantation remains under investigation.
• This study assesses outcomes after switching from steroid-based immunosuppression to EVR in ABOi kidney transplant recipients.

Purpose of the Study:

• To evaluate the effectiveness of converting from steroid to everolimus (EVR) in ABO-incompatible (ABOi) kidney transplant recipients.
• To compare graft outcomes, glycemic control, and cytomegalovirus (CMV) infection rates between EVR and steroid groups.

Main Methods:

• A retrospective cohort study included 33 adult ABOi living donor kidney transplant recipients.
• Desensitization involved plasmapheresis and rituximab; immunosuppression included tacrolimus, mycophenolate mofetil, and methylprednisolone.
• Diabetic patients were switched from methylprednisolone to EVR to manage diabetes progression, with outcomes compared to a steroid group.

Main Results:

• Graft survival (100% vs 95.5%), acute rejection rates (9.1% vs 18.2%), and serum creatinine levels were comparable between EVR and steroid groups.
• Hemoglobin A1c (HbA1c) levels did not significantly worsen in the EVR group, unlike the steroid group (P=.003).
• Cytomegalovirus infection rates were significantly lower in the EVR group (18.2%) compared to the steroid group (63.6%, P=.026).

Conclusions:

• Conversion from steroids to everolimus in ABOi kidney transplant recipients preserves excellent graft outcomes.
• This conversion strategy effectively prevents diabetes progression and reduces cytomegalovirus infections.