Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background: Previous studies reported efficacy and safety of steroid-free regimens after kidney transplant (KT). However, there is no robust evidence on this strategy in patients receiving low-dose tacrolimus (TAC) and everolimus (EVR).
Methods: Single center retrospective study including adults (>18y), non-identical living or deceased low risk transplants (First KT, PRA<50%, no DSA) performed between Jun/12-Jun/16, submitted to steroid avoidance regimen based on TAC (4-7ng/mL) combined with EVR (3-6ng/mL) (n=201) or mycophenolate (MPS, n=65). 1y efficacy and safety outcomes were evaluated.
Results: Demography was similar between groups: recipients predominantly men (78%), young (46±14y), mixed race (72%), low immunological risk (median PRA I/II=0/0)%, mean HLA MM=3.4±1.2) who received kidneys from deceased (96%), young (31±12y) donors. Mean cold ischemia time was 25±7h. 99% received rATG induction, mean dose 5.4±1mg/Kg. Main outcomes are shown in Table1.
Table 1. 1y outcomes
|EVR (n=201)||MPS (n=65)|
|DGF*||95/194 (49%)||17/62 (27%)|
|Treated AR||17 (8.5%)||4 (6.2%)|
|BPAR||5 (2.5%)||2 (3.1%)|
|NODAT||31/153 (20%)||9/56 (16%)|
|Statins*||106 (53%)||24 (37%)|
|Weight variation (Kg) – median||+1.0||-0.5|
|eGFR (mL/min) – MDRD||64±26||72±28|
|Graft loss||6 (2.9%)||2 (3.1%)|
|Death||8 (3.9%)||1 (1.5%)|
|Composite endpoint#||45 (22.4%)||17 (26.2%)|
|Steroid use at 1y||14 (6.9%)||5 (7.7%)|
DGF:delayed graft function, AR: acute rejection; BPAR: biopsy proven acute rejection; NODAT:new onset diabetes after transplantation, eGFR: estimated glomerular filtration rate.
#Graft loss, death or EVR/MPS discontinuation
In multivariable analysis, recipient age (OR 0.970), PRA II (OR 1.058) and HLA MM (OR 1.494) were risk factors for treated AR.
Conclusion: Efficacy outcomes were excellent and similar between EVR and MPS groups. No significant weight gain and low rates of steroid introduction occurred in both groups. EVR was not associated with increased risk of AR.
CITATION INFORMATION: Sandes-Freitas T., Sales M., Oliveira J., Oliveira M., Dantas G., Girão C., Esmeraldo R. Steroid Avoidance in Renal Transplant Patients Treated with Everolimus and Low-Exposure Tacrolimus Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Sandes-Freitas T, Sales M, Oliveira J, Oliveira M, Dantas G, Girão C, Esmeraldo R. Steroid Avoidance in Renal Transplant Patients Treated with Everolimus and Low-Exposure Tacrolimus [abstract]. https://atcmeetingabstracts.com/abstract/steroid-avoidance-in-renal-transplant-patients-treated-with-everolimus-and-low-exposure-tacrolimus/. Accessed June 25, 2019.
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