Background: Everolimus (EVR)-based calcineurin inhibitor (CNI)free regimen has been used to avoid CNI toxicity, although it was not concluded for conversion in kidney transplant recipients during the maintenance period. EVR, an m-TOR inhibitor, is known for its benefits of reducing the toxicity of CNIs and the incidence of CMV/BK infections and malignancies. However, only a few studies have reported conversion from CNI to EVR.
Method: We performed a single-center retrospective analysis to evaluate the short-term outcomes of patients who converted from CNI to EVR between December 2011 and November 2012. 25 patients converted from a CNI and mycophenolate mofetil (MMF) regimen to an EVR and MMF regimen (Group A) and 39 from a CNI and MMF regimen to a CNI and EVR regimen (Group B). Medrol was given to all patients. The indication for conversion from CNI to EVR included adequate renal function (creatinine (Cr) level < 3.0 mg/dl) and that from MMF to EVR was to enable reduction of adverse effects such as diarrhea and PTLD.
Results: The mean period from transplantation to conversion was 6.54 ± 3.86 and 7.05 ± 6.64 years in Groups A and B, respectively. The mean age at conversion was 45.8 ± 12.9 and 47.4 ± 11.9 years. The initial EVR dose was 1.0 or 2.0 mg/d in both groups. The mean EVR trough level at 1 month after introduction was 1.82 ± 1.13 ng/ml in Group A and 1.58 ± 0.78 ng/ml in Group B (p = 0.271). Several EVR-related adverse events persisted, including edema (n = 10, 15.6%), increased urinary protein levels (n = 8, 12.5%), and thrombosis (n = 2, 3.1%). In Group A, the mean Cr level for 3 months before conversion was 1.34 ± 0.40 ng/ml and that after conversion was 1.47 ± 0.69 ng/ml (p = 0.551); in Group B, the levels before and after conversion were 1.67 ± 0.51 and 1.63 ± 0.45 ng/ml, respectively (p = 0.860). The difference in the mean Cr level before and after conversion (ΔCr) was 0.14 ± 0.44 ng/ml in Group A and −0.038 ± 0.15 ng/ml in Group B (p = 0.022).
Conclusion: The short-term outcomes obtained for conversion from a CNI-based regimen to an EVR-based one in renal transplant recipients during the maintenance period suggest that this conversion is safe and that it is possible to avoid CNIs or decrease their dosage to avoid or decrease their diverse adverse effects.
To cite this abstract in AMA style:Kutsunai K, Iwadoh K, Horibe T, Ogawa Y, Kai K, Murakami T, Koyama I, Nakajima I, Fuchinoue S. Short-Term Outcomes of the Calcineurin Inhibitor Avoidance Maintenance Regimen with Everolimus in Kidney Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/short-term-outcomes-of-the-calcineurin-inhibitor-avoidance-maintenance-regimen-with-everolimus-in-kidney-transplant-recipients/. Accessed November 27, 2020.
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