Introduction. The use of m_TOR inhibitors sirolimus (SRL) and everolimus (EVL), in kidney transplant recipients (KTR) is an alternative immunosuppressive therapy to reduce or withdrawal calcineurin inhibitors (CNI) in patients with CNI associated toxicity or malignancy.

We reviewed our experience in KTR switched from calcineurin inhibitor (CNI) to SRL or EVL.

Methods. We retrospectively analyzed KTR with m-TOR conversion from 2001 to 2013 in a transplant center of a developing country. We started SRL and EVL and simultaneous CNIs withdrawal . Previous m-TOR conversion graft biopsy , GFR and urinary P/C index were done. Descriptive and graft survival analysis was done with STATA 12. Results. Among 1316 KTR, m-TOR conversion was found in 127 (9.6%) patients, 101 (80%) were switched to SRL and 26 (20%)to EVL Mean age at m-TOR conversion was 47±13 yr and 54% were male. The CNI previous m-TOR conversion was Tacrolimus 8% and Cyclosporine A 92%. The 88% were taken mycophenolic acid. On conversion, 71 (56%) had toxicity due to CNI and 45 (35%) patients had malignancy , 23 of these skin cancer, 8 had PTLD and 14 other tumors. Median time of m-TOR conversion after KT was 12 months (IQR: 4 – 41) and median time of follow up after m-TOR conversion was 48 months (IQR: 24-79). Graft survival at 1 and 5 years after m-TOR conversion was 96% and 86% respectively. After m-TOR conversion, one year acute graft rejection incidence was 6.5%, 3 (3.6%) patients had de novo malignancy, 15 (12%) patients were removed from m-TOR and 5 patients died. Deaths were due to malignancy and sepsis 3 and 2 patients respectively. Conclusions. We found a similar graft and patient survival after m-TOR conversion compared to our whole group of kidney transplant recipients and a low incidence of new malignancies and acute graft rejection .

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