Background: Although steroid withdrawal from conventional immunosuppressive therapy has been attempted to ameliorate various complications, especially diabetes mellitus (DM), in kidney transplant recipients, a steroid-sparing strategy has more frequently led to acute rejection of transplantationinsuch patients. In this study, we investigated the use of everolimus (EVR) to safely overcome steroid withdrawal in kidney transplant recipients under maintenance immunosuppressive therapy.

Methods: In total, 75 kidney transplant recipients received conventional immunosuppressive therapy comprising tacrolimus (C₀ 5 ng/mL), mycophenolate mofetil (1000 mg), and methylprednisolone (4 mg). Among them, patients with DM underwent simultaneous EVR administration (C₀ 3–5 ng/mL) and steroid withdrawal at 1–15 months post-transplantation. Graft survival and acute rejection rate was compared between patients with and without DM. Among patients with DM, renal function as well as hemoglobin A1c and glycoalbumin levels after 1 year of steroid withdrawal were compared with those prior to initiation of the withdrawal.

Results: The mean duration of follow-up after transplantation in the DM (n = 25) and non-DM (n = 50) groups was 614 and 689 days, respectively. All grafts survived in both groups, and biopsy-proven acute rejection rate showed no significant difference between the DM and non-DM groups (12% vs. 16%, P = 0.72); furthermore, no acute rejection occurred after steroid withdrawal. In the DM group, no significant difference was observed in serum creatinine levels (1.28 ± 0.35 vs. 1.21 ± 0.30 mg/dL, P = 0.70), estimated glomerular filtration rate (49.0 ± 13.8 vs. 51.6 ± 11.4 mL/min/1.73 m², P = 0.47), and insulin administration rate (28% vs. 36%, P = 0.76) before and after 1 year of steroid withdrawal. However, hemoglobin A1c (6.94% vs. 6.43%, P = 0.62) and glycoalbumin (18.0% vs. 15.9%, P = 0.58) levels decreased after steroid withdrawal.

Conclusions: Steroid withdrawal with concomitant use of EVR as maintenance immunosuppressive therapy for kidney transplant recipients may safely ameliorate post-transplant DM, achieve better glycemic control, and maintain stable renal function.

CITATION INFORMATION: Nanmoku K, Kurosawa A, Kubo T, Shinzato T, Shimizu T, Kimura T, Yagisawa T. Steroid Withdrawal Using Everolimus in Maintenance Kidney Transplant Recipients with Post-Transplant Diabetes Mellitus. Am J Transplant. 2017;17 (suppl 3).

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