Everolimus Versus Mycophenolate for Recipients of Kidney Transplants from Expanded Criteria Donors (ECD) Receiving Anti-Thymocyte Globulin and Tacrolimus

H. Tedesco-Silva,¹ C. Felipe,¹ A. Ferreira,¹ M. Cristelli,¹ A. Bessa,¹ P. Ueno,¹ T. Sandes- Freitas,¹ G. Bassos,¹ W. Aguiar,² H. Proença,³ J. Medina-Pestana.¹

¹Nephrology, Hospital do Rim UNIFESP, Sao Paulo, Brazil
²Urology, Hospital do Rim UNIFESP, Sao Paulo, Brazil
³Pathology, UNIFESP, Sao Paulo, Brazil.

Meeting: 2015 American Transplant Congress

Abstract number: 294

Keywords: Cytomeglovirus, Donors, Immunosuppression, Kidney transplantation, marginal

Session Information

Session Name: Concurrent Session: Kidney: KDPI and Non Ideal Kidneys

Session Type: Concurrent Session

Date: Monday, May 4, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 4:48pm-5:00pm

Location: Room 118-AB

Introduction: Recipients of kidneys recovered from expanded criteria donors are at higher risk to develop delayed graft function (DGF) and acute rejection (AR), leading to inferior graft function and graft survival. The ideal immunosuppressive regimen for these recipients has not been defined. Objectives: Our study compared the efficacy and safety of everolimus (EVR) or mycophenolate sodium (MPS) in ECD kidney transplant recipients receiving induction therapy with anti-thymocyte globulin, tacrolimus (TAC) and prednisone. Methods: This is a prospective, randomized, single center study designed to enroll 200 patients (1:1) to receive induction therapy with anti-thymocyte globulin, prednisone, delayed introduction of TAC (day 7) and EVR (EVR group) or MPS (MPS group). This preliminary analysis was performed with 84 randomized patients (n=44, EVR and n=40, MPS) with a median follow up of 7 months. Preemptive strategy was use for CMV infection. Results: There were no differences in mean kidney donor profile index (KDPI, 89±7 vs. 88±11%) and mean kidney donor risk index (KDRI, 1.6±0.2 vs. 1.7±0.1) comparing EVR and MPS groups, respectively. There were no differences in main demographic characteristics except the incidence of diabetes mellitus (EVR, 36% vs. MPS, 10%). There was no difference in incidence of DGF (64 vs. 70%, p=0.537) but a tendency to lower duration in DGF (9.8±7.5 vs. 6.5±5.1 days, p=0.057) in MPS group. The incidence of first CMV infection was lower in EVR group (13 vs. 87%, p=0,000) and 43% patients in MPS (n=15) developed at least one recurrent event of CMV infection. Higher incidence of treated AR (36 vs 23%, p=0.165) or treated biopsy confirmed AR (16 vs. 8%, p= 0.235) was observed in the EVR group. No differences in mean estimated glomerular filtration rate (MRDR, 41±19 vs. 46±14 mL/min, p= 0.285) were observed at 6 months. Treatment discontinuation occurred in 6 patients in EVR and 12 patients in MPS group. Conclusions: This preliminary analysis indicates that patients receiving EVR are at lower risk of developing CMV infection but a tendency to higher incidence of acute rejection compared to patients receiving MPS.

To cite this abstract in AMA style:

Tedesco-Silva H, Felipe C, Ferreira A, Cristelli M, Bessa A, Ueno P, Freitas TSandes-, Bassos G, Aguiar W, Proença H, Medina-Pestana J. Everolimus Versus Mycophenolate for Recipients of Kidney Transplants from Expanded Criteria Donors (ECD) Receiving Anti-Thymocyte Globulin and Tacrolimus [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/everolimus-versus-mycophenolate-for-recipients-of-kidney-transplants-from-expanded-criteria-donors-ecd-receiving-anti-thymocyte-globulin-and-tacrolimus/. Accessed May 11, 2025.

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