Everolimus and Low Dose Cyclosporine Immunosuppressive Regimen and Development of Anti HLA Donor Specific Antibodies.
1Nephrology unit, Careggi University Hospital, Florence, Italy
2Nephrology Unit, Mayer Univerity Hospital, Florence, Italy.
Meeting: 2016 American Transplant Congress
Abstract number: B123
Keywords: Antibodies, Calcineurin, Kidney transplantation
Session Information
Session Name: Poster Session B: Drug Minimization
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Few data are available on the rate of de novo anti-HLA donor specific antibodies (DSA) with the use of everolimus in kidney transplant recipients.
Materials
We selected among the recipients of a kidney graft performed in our unit between 2002 and 2013 those treated with everolimus, cyclosporin low dose and steroids (group EVE, n:85) or cyclosporin standard dose, mycofenolate and steroids (MPA, n:182). All received basiliximab induction. Then we compared retrospectively the prevalence of anti HLA DSA detected by Luminex in those followed with at least one yearly visit in our center. We also compared renal function and the development of biopsy proven antibody-mediated rejection. The statistical tests included Student t test and Wilcoxon's rank-sum, [Chi][sup2] test or Fisher's exact test as appropriate
Results
Graft loss was 14% in EVE and 21% in MPA (p:0.13). Finally 48 patients in group Eve and 107 in MPA were evaluated. Baseline data and renal function are summarized in
| Parameter | EVE | MPA | p value |
|
Cyclosporine trough level range (ng/ml) |
50-75 | 100-150 | |
| Everolimus levels (ng/ml) | 5-10 | – | |
|
Age at transplant (years) |
47,2 ± 12,4 |
48.2± 12.7 |
0.63 |
|
Follow up (years) |
5.0± 2.4 |
5.2± 3.2 |
0.58 |
|
Male sex |
68% |
59% | 0.28 |
| Serum creatinine (mg/dl) |
1.6± 0.6 |
1.4± 0.5 |
0.063 |
|
eGFR (ml/min) |
51.8 ±21.8 |
54.3 ±19.8 |
0.49 |
|
Proteinuria (mg/24 hours) Median and range |
374 (0-5363) |
187 (0-3036) |
0.054 |
|
Anti HLA antibodies |
14% |
19% |
0.45 |
|
Anti HLA DSA |
– | 4.7% | 1.28 |
. The prevalence of anti HLA antibodies was 14% and 19 % respectively in Eve Vs MPA patients (p 0.45). We registered only 5 cases of anti DSA antibodies (3 of whom with C4d deposition on the peritubular capillaries of the allograft biopsy) in MPA patients and no one in the Eve group.
Discussion
We found only 5 MPA patients with anti HLA DSA antibodies and none in the EVE group. This work has several limitations: we have no data of DSA in patients with graft failure since luminex assay has become routinely used only recently. This was partially corrected by a non different rate of graft loss in both groups. Finally it's impossible to indicate if anti DQ antibodies are DSA since donor HLA DQ typing was not performed routinely. Our favorable results with a combination of everolimus and low dose cyclosporine should be confirmed by a prospective study.
CITATION INFORMATION: Minetti E, Di Maria L, Caroti L, Buti E, Carta P. Everolimus and Low Dose Cyclosporine Immunosuppressive Regimen and Development of Anti HLA Donor Specific Antibodies. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Minetti E, Maria LDi, Caroti L, Buti E, Carta P. Everolimus and Low Dose Cyclosporine Immunosuppressive Regimen and Development of Anti HLA Donor Specific Antibodies. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/everolimus-and-low-dose-cyclosporine-immunosuppressive-regimen-and-development-of-anti-hla-donor-specific-antibodies/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress