Delayed Tacrolimus (TAC) to Rapamycin (RAPA) Conversion in Renal Transplant Recipients With DGF/SGF

A. Haririan,¹ D. Klassen,¹ M. Keshtkar,¹ C. Drachenberg,² T. Dowling,³ E. Ramos,¹ R. Ugarte,¹ C. Cangro,¹ M. Weir.¹

¹Medicine, University of Maryland, Baltimore, MD
²Pathology, University of Maryland, Baltimore, MD
³Pharmacy, University of Maryland, Baltimore, MD.

Meeting: 2015 American Transplant Congress

Abstract number: D139

Keywords: Graft function, Kidney transplantation, Outcome, Rapamycin

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

The role of conversion from TAC to RAPA early after kidney transplantation in patients with DGF/SGF in improving graft function and delaying chronic allograft dysfunction remains unclear . We conducted a prospective, randomized, open label conversion study in 32 deceased donor renal transplant recipients with history of DGF/SGF.

All patients received induction therapy, followed by TAC/MMF maintenance. Eligible study subjects were randomized into two groups 8-24 weeks posttransplant, remaining on ATC or switching to Rapa. Patients were followed for one year. Data were analyzed with intention-to-treat approach.

15 patients were randomized to receive RAPA and 17 patients remained on TAC. The groups were comparable regarding age, sex, race, diabetes, prior transplant, HLA MM, PRA, induction, and donor characteristics.

During follow-up period 2 patients in the TAC group (11.8%) were switched to RAPA and 6 in RAPA group (40%) were converted back to TAC (P=0.11). During this period 4 subjects in RAPA group experienced ACR, one had ACR/chronic AMR, and one developed chronic AMR. In the TAC group one subject experienced ACR and one had mixed ACR/AMR (P=0.064). Chronic changes in biopsy indicated by CADI score, increased by > 0.5 in 43.8% of the cases in TAC group and in 58.3% of the patients in RAPA group (P=0.7). There was no statistically significant difference in eGFR and measured GFR by iothalamate, urine albumin excretion, and blood pressure at 12 months, and the groups were similar regarding change in these variables from baseline. During the study period 2 patients in RAPA group experienced graft failure and one died of sepsis. In the TAC group one patient had graft failure (P=0.25).

The level of inflammatory markers, CRP, IL-6 and MCP at the end of the study and their change from baseline were comparable between the two groups.

The results of this single-center, randomized, open-label trial of early TAC to RAPA conversion, in a “real-life” setting did not show any significant beneficial effect on delaying chronic histological changes, improving graft function or inflammatory cytokines in kidney transplant recipients who experience DGF/SGF.

To cite this abstract in AMA style:

Haririan A, Klassen D, Keshtkar M, Drachenberg C, Dowling T, Ramos E, Ugarte R, Cangro C, Weir M. Delayed Tacrolimus (TAC) to Rapamycin (RAPA) Conversion in Renal Transplant Recipients With DGF/SGF [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/delayed-tacrolimus-tac-to-rapamycin-rapa-conversion-in-renal-transplant-recipients-with-dgfsgf/. Accessed November 21, 2024.

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