Evolving to Everolimus: A Safe and Effective Option for Pancreas Transplant.
University of Utah Health Care, Salt Lake City, UT.
Meeting: 2016 American Transplant Congress
Abstract number: A66
Keywords: Adverse effects, Dyslipidemia, Graft survival, Insulin
Session Information
Session Name: Poster Session A: Clinical Pancreas Transplantation and All Islet Cell Transplantation Topics
Session Type: Poster Session
Date: Saturday, June 11, 2016
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Although everolimus is an attractive option for conversion therapy in pancreas tx pts that experience SE's of commonly used immunosuppression, TAC and MPA, there is limited data available on EVR in this population.
Methods: We conducted a retrospective chart review of pancreas tx pts converted from MPA to EVR (CONV). Outcomes were compared to pts that received TAC,MPA and steroids (SOC).
Results: Between May 2012-July 2015, 34 pts received a pancreas tx, 21(62%) were CONV(16 SPK, 3 PAK, 2 PTA) an average of 5.9 months after tx. 13 pts remained on SOC (10 SPK, 3 PAK). Baseline characteristics were similar in both groups. Reasons for EVR conversion include: leukopenia, GI SEs, CMV, BK viremia, and disseminated adenovirus. After conversion, there was less leukopenia (57 vs 38%) and GI SEs (57 vs 10%) with EVR. Rates of CMV and BK were similar between pts Pre vs Post-CONV. The pt with adenovirus became non-detectable by 1 mnth post conversion.
Proteinuria was similar between groups (19%). No documented pneumonitis or graft thrombosis occured in CONV. Stomatitis (4 vs 0) and poor wound healing (4 vs 2) were > in CONV. Viral infection (5 vs 2) and bacteremia/sepsis (3 vs 0) were < in CONV. Avg TG level were similar between groups (138 CONV vs 146 SOC).
| CONV (n=21) | ||
| Pre-CONV | Post-CONV | |
| Stomatitis | 0 | 4 (19%) |
| Anemia | 8 (38%) | 4 (19%) |
| Wound healing comp | 2 (10%) | 4 (19%) |
| Leukopenia | 12(57%) | 8 (38%) |
| Infx | 10 (48%) | 7 (33%) |
| -Thrush | 0 | 2 (10%) |
| -Cellulitis/Wound Infx | 2 (10%) | 3 (14%) |
| -Bacteremia/Sepsis | 3 (14%) | 0 |
| TG (avg mg/dL) | 138 | 146 |
| CMV | 3 (14%) | 2 (10%) |
| BK Viremia | 2 (10%) | 1 (5%) |
| Proteinuria | 4 (19%) | 4 (19%) |
| -New | – | 3 (14%) |
| -Improved | – | 3 (14%) |
Pt and graft survival were > in the CONV arm (95%) vs SOC (85%). 2 deaths occured in the SOC arm vs 1 in the CONV arm. 3 pts treated for suspected rejection, 1 on SOC and 2 on CONV. 1 SOC pt required insulin re-initiation. 15 pts (71%) remained on EVR. Reasons for stopping EVR included stomatitis (2), GI SE (1), non-healing wound (1), proteinuria (1), and death (1).
| SOC (n=13) | CONV (n=21) | |
| Patient Survival | 11 (85%) | 20 (95%) |
| Graft Survival | 11 (85%) | 20 (95%) |
| Biopsy Proven Rejection | – | – |
| Treatment for Suspected Rejection | 1 (15%) | 2 (10%) |
| Initiation of Insulin | 1 (15%) | – |
Conclusion: EVR is a safe and effective option for Panc tx, with low overall SE, no increase in REJ or initiation of insulin. EVR in panc tx requires further study.
CITATION INFORMATION: Yeager S, Carlson A, Truax C, Kenyon N, Ahmed F, Corbett J, Shihab F, Smith L. Evolving to Everolimus: A Safe and Effective Option for Pancreas Transplant. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Yeager S, Carlson A, Truax C, Kenyon N, Ahmed F, Corbett J, Shihab F, Smith L. Evolving to Everolimus: A Safe and Effective Option for Pancreas Transplant. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/evolving-to-everolimus-a-safe-and-effective-option-for-pancreas-transplant/. Accessed November 25, 2024.« Back to 2016 American Transplant Congress