EVR/rTac has been reported to improve renal function in LT recipients with adequate kidney function (eGFR > 80ml/min); however, this strategy in LT patients with moderate to severe KD (eGFR 15-59ml/min) is unclear. We report our experience with EVR/rTac conversion in LT patients with moderate to severe KD to assess clinical outcomes. Methods: LT recipients with moderate to severe KD were screened for initiation of EVR/rTac between 4/2013 and 10/2015. Exclusion criteria included baseline proteinuria (> 0.5gm/day or <0.5gm/day with significant comorbidity), absolute neutrophil count < 1200/UL, or active hepatitis C. EVR and Tac levels, kidney function, urinary protein, and lipid were monitored pre- and post- EVR/rTac conversion. Rejection and adverse events were analyzed. Results: Forty seven patients underwent screening. Twenty four patients were ineligible for conversion and 1 patient's KD resolved [table 1]. Of the 22 patients undergoing conversion, 16 patients discontinued EVR due to EVR adverse events. The mean therapy was 325 days. Tac levels were significantly lower after EVR/rTac conversion but the renal function remained unchanged [table 2]. No patients experienced rejection. Of the 6 remaining patients on EVR/rTac, 5 are on lipid lower agents and 4 are on ACEi/ARB. Conclusions: Most LT patients with moderate to severe KD had risk factors rendering them ineligible for EVR/rTac conversion. In those converters, 73% of them withdrew primarily due to EVR-associated adverse effects. In selected patients with moderate to severe KD, conversion to EVR/rTac may be an alternative strategy to reserve renal function.

CITATION INFORMATION: Pan S.-H, Kim I, Klein A, Annamalai A, Todo T, Nissen N. Only 13% of Liver Transplant (LT) Recipients with Moderate to Severe Kidney Disease (KD) Tolerate Conversion to Everolimus and Reduced Tacrolimus (EVR/rTac). Am J Transplant. 2016;16 (suppl 3).

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