Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Transplant outcome and protocol stay rate of everolimus were investigated to clarify efficacy and risk of everolimus based regimens at a single institute.
*Methods: During March 2008 and December 2109, 1127 living-kidney transplant for a low risk patient were performed at our institute. All patients are ABO matched or compatible transplant. Immunosuppression regimen included either CSA, tacrolimus or extended release tacrolimus with mycophenolate mofetil (MMF), mizoribin, or everolimus. Induction therapy by basiliximab was given. Steroid was used with taper. Everolimus was converted to MMF in the setting of severe rejection, sever adverse effect, bone fracture and necessity of major surgery. Kaplan-Meier was used for survival analysis and cox hazard model was used for hazard ratio. P<0.05 was considered significant.
*Results: There were 167 patients with everolimus included regimen (EVR) and 960 patients without everolimus (nonEVR). CSA was given in 105 patients (62.8%) in EVR group, whereas 344 patients (35.8%) in nonEVR group. With a mean observation period of 5.4 (0.1-11.9) years, overall patient survival at 1 and 5 year were 99.3% and 98.4% in EVR group and 99.6% and 97.9% in nonEVR group (p=0.9151). Over all graft survival at 1 and 5 years were 99.3% and 95.6% in EVR group and 99.2% and 94.8% in nonEVR group (p=0.372). Protocol stay rate on EVR group at 1 and 5 year were 90.6% and 74.3%. Average months of conversion was 14.0 months after transplant. Timing of MMF conversion was significantly earlier in tacrolimus based regimen (8.2 months in Tac and 17.1 months in CSA; p=0.0369). Reasons of drop-out were rejection 6, bone fracture 6, major surgery 6, DVT 2, and adverse effect 3. Antibody mediated rejection occurred within a month solely in 3 patients with EVR and extended release tacrolimus regimen.
*Conclusions: Everolimus based immunosuppression provides equivalent or even better clinical outcomes. Overall protocol stay rate is acceptable but special attention focused on antibody-mediated rejection should be necessary especially in combination with extended release tacrolimus. Further follow-up should be inevitable.
To cite this abstract in AMA style:Narumi S, Watarai Y, Goto N, Hiramtsu T, Okada M, Futamura K, Tomosugi T, Kanda A, Kobayashi T. Efficacy and Possible Risk of De Novo Use of Everolimus for Primary Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/efficacy-and-possible-risk-of-de-novo-use-of-everolimus-for-primary-kidney-transplantation/. Accessed October 27, 2020.
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