Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Calcineurin(CNI) based therapy is the cornerstone of immunosuppresion(IS) after kidney transplant. However chronic nephrotoxicity from CNI as been implicated in post-transplant renal dysfunction. We hypothesized that lowering CNI exposure in combination with low dose Everolimus may result in better graft outcomes, possibly related to an effect on T-regulatory cells.
Methods: We conducted a prospective study in adult living donor kidney transplant recipients randomized to steroid free IS with low dose Tacrolimus(Tac) and Everolimus (n=19) or standard dose Tac and Mycophenolate Mofetil (n=20). All patients received Alemtuzumab induction. Everolimus levels were maintained between 3-8 ng/ml. In the standard IS group Tac levels were maintained between 8-10 ng/ml upto 2 months, 6-8 ng/ml from 2- 6 months and 4-8 ng/ml after 6 months post-transplant. Tac levels in the low dose group were maintained between 4-7 ng/ml upto 2 months, 3-5 ng/ml from 3-6 months and 2-5 ng/ml after 6 months post-transplant, reflecting a 50% lower dose than standard IS. Follow up included protocol kidney biopsy at 3 and 12 months post-transplant. Primary outcomes were graft survival, rejection free graft survival and estimated GFR.
Results: Mean age at transplant was 47±16 and 50±14 years in the Tac+Everolimus and Tac+MMF group respectively (p=0.42). Other baseline characteristics including demographics, HLA match and time on dialysis were statistically similar. There was no difference in primary outcomes or adverse events between the two groups.
|n = 19||n = 20|
|Mean Follow up (months)*||13 ± 4||14 ± 4||0.22|
|Graft Survival (percent)||100||100||1.00|
|Graft function (eGFR in ml/min/1.73m2)*||70 ± 23||66 ± 22||0.55|
|Development of Denovo DSA without rejection||1||1||1.00|
|Proteinuria > 1g/day||2||0||0.49|
To cite this abstract in AMA style:Shetty A, Leventhal J, Traitanon O, Alvarado A, Mas V, Mathew J, Tantisattamo E, Gallon L. Prospective Study of a Steroid Free, Low Dose Tacrolimus and Everolimus Combination Regimen in Kidney Transplant [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/prospective-study-of-a-steroid-free-low-dose-tacrolimus-and-everolimus-combination-regimen-in-kidney-transplant/. Accessed August 3, 2020.
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