Calcineurin Inhibitors (CNI) Minimization Associated With Mammalian Target of Rapamycin Inhibitors (i-mTOR) to Improve Renal Function in Renal Grafts from Uncontrolled Donation After Cardiac Death Donors (UDCDD)

M. Molina,¹ E. Gutierrez,¹ S. González-Sanchidrian,² E. González,¹ J. Cabrera,¹ N. Polanco,¹ A. Hernández,¹ A. Sevillano,¹ M. Praga,¹ A. Andres.¹

¹Nephrology, Hospital 12 de Octubre, Madrid, Spain
²Nephrology, Hospital San Pedro de Alcántara, Caceres, Spain.

Meeting: 2015 American Transplant Congress

Abstract number: D138

Keywords: Donors, Immunosuppression, Kidney transplantation, non-heart-beating, Renal dysfunction

Session Information

Session Name: Poster Session D: Kidney Immunosuppression: Drug Minimization

Session Type: Poster Session

Date: Tuesday, May 5, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

INTRODUCTION: Ischemia injury in kidneys grafts from UDCDD could produce a poor renal function. Minimized blood levels of CNI associated with i-mTOR therapy could avoid acute rejection and decreased CNI nephrotoxicity.

AIM: Describe evolution of renal function before and after CNI minimization associated with conversion from MMF to i-mTOR in a population with renal transplants from UDCDD.

MATERIAL AND METHOD: All kidney transplant recipients from UDCDD received steroids, tymoglobuline, mycophenolate (MMF) and delayed introduction of CNI(tacrolimus). Blood levels of tacrolimus had to be between 8-10 ng/mL at first months after transplantation. We selected for our study patients in whom the immunosuppression was changed after 3 months of transplantation minimization of tacrolimus blood levels to 5 ng/mL and conversion from MMF to i-mTOR. We evaluated renal function before and after these change.

RESULTS: Our center have performed 207 kidney transplants from UDCDD. Minimization of tacrolimus blood levels (10 to 5 ng/mL) and conversion from MMF to i-mTOR was performed in 46 (22%) cases at 11 (6,32) months from transplantation. Causes of immunosuppression change were: 20 (44%) CNI nephrotoxicity, 14 (30%) neoplasm, 6 (13%) clinical trials, 3 (7%) viral infections, 1 (2%) BK nephropathy, 1 (2%) posttransplantation diabetes and 1 (2%) gastrointestinal intolerance to MMF. The evolution of Serum Creatinine, Glomerular Filtration Rate (GFR), proteinuria and delta annual GFR at one year before, basal, 3 months and 1 year after is showed in Table 1.


	1 year before	Basal	3 months	1 year after
Serum Creatinine (mg/dL)	1.4 ± 0.4*	1.6 ± 0.4	1.5 ± 0.4*	1.5 ± 0.5
GFR (mL/min)	57 ± 22	50 ± 19	54 ± 20*	52 ± 17
Proteinuria (g/day)	0.2 (0.1-0.4)	0.2 (0.1-0.3)	0.2 (0.2-0.4)*	0.3 (0.2-0.4)*
δ annual GFR		-4 (-10,5)		9 (-3,8)

*p<0.05

Withdrawn of i-mTOR occurred in 8 (17%) patients: 3 edemas, 2 intolerance to i-MTOR, 1 proteinuria, 1 pneumonitis and 1 neurological symptoms. None patients had an acute rejection after i-MTOR introduction.

CONCLUSSIONS: Minimization of tacrolimus blood levels and conversion from MMF to i-mTOR in kidney transplant from UDCDD is efficient and safe with low rate of i-MTOR withdrawn and improves renal function.

To cite this abstract in AMA style:

Molina M, Gutierrez E, González-Sanchidrian S, González E, Cabrera J, Polanco N, Hernández A, Sevillano A, Praga M, Andres A. Calcineurin Inhibitors (CNI) Minimization Associated With Mammalian Target of Rapamycin Inhibitors (i-mTOR) to Improve Renal Function in Renal Grafts from Uncontrolled Donation After Cardiac Death Donors (UDCDD) [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/calcineurin-inhibitors-cni-minimization-associated-with-mammalian-target-of-rapamycin-inhibitors-i-mtor-to-improve-renal-function-in-renal-grafts-from-uncontrolled-donation-after-cardiac-death-don/. Accessed November 21, 2024.

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