*Purpose: There are scarce evidence on the efficacy and safety of everolimus (EVR)-based regimens in pediatric kidney transplantation (KT).

*Methods: This single center retrospective cohort analyzed 1-year outcomes of KT performed in patients under 18 yo between Jan/11 and Feb/17 who received tacrolimus (TAC) associated with EVR (n=67) or mycophenolate (MPA, n=64). According to center protocol, TAC-MPA was adopted as initial immunosuppressive regimen (IS) until 2012, when EVR replaced MPA. Antithymocyte globulin (rATG) was used as induction therapy and steroids were prescribed for high-risk patients and those with autoimmune diseases. CMV prophylaxis was routinely employed until 2012, when preemptive approach was adopted.

*Results: Groups were similar in respect to gender (male, 57%), age (12±5 yo), CKD etiology (uropathy, 35%), time on dialysis (median 12 mo), PRA (median 0%), donor age (16±6 yo), HLA MM (4.7±1), cold ischemia time (22±7h) and CMV serostatus (R-, 23%). Group EVR had more deceased donors (100 vs. 66%, p=0.001), more patients on steroid-free strategy (87 vs. 59%, p=0.001) and received less valganciclovir prophylaxis (19 vs. 36%,p=0.050). There were no differences on treated AR episodes (10 vs. 22%, p=0.096), biopsy-proven AR (9 vs.14%, p=0,418), IS discontinuation (25 vs. 16%, p=0,198), renal function (TFG-Schwartz 58±24 vs. 66±29 mL/min, p=0.166), death-censored graft survival (95 vs. 97%, p=0.967) or patient survival (97 vs. 100%, p=0.406). The incidence of CMV events was higher in MPA group (24 vs. 52%, p=0.002). In multivariable analysis, CMV serostatus (IgG R-) (OR 4.557, 95%CI 1.659-12.519, p=0.003), prophylaxis with valganciclovir (OR 0.178, 95%CI 0.060-0.529, p=0.002) and EVR (OR 0.208, 95%CI 0.089-0.468, p=0.000) were risk factors for CMV events.

*Conclusions: EVR-based regimen was effective and safe in this pediatric population, and was independently associated with lower risk for CMV.

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