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Year : 2015  |  Volume : 9  |  Issue : 4  |  Page : 144-151

Replacement of calcineurin inhibitors with everolimus: Long-term impact in renal transplant recipients – A single center study

1 Transimmun – Transplantation Immunology & Research Centre, Somajiguda, Hyderabad 500082, AP, India
2 Department of Nephrology and Transplantation, Krishna Institute of Medical Sciences, Hyderabad 500003, AP, India

Correspondence Address:
Kesiraju Sailaja
Transimmun – Transplantation Immunology & Research Centre, Somajiguda, Hyderabad 500082, AP
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Source of Support: None, Conflict of Interest: None

DOI: 10.1016/j.ijt.2015.10.015

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Background: Calcineurin inhibitor withdrawal with introduction of mammalian target of rapamycin inhibitors is associated with improvement in the renal function. The aim of the study was to evaluate the long-term allograft function after a complete switch over to everolimus from CNI at different time points. Methods: Single center prospective, observational, follow-up study, in which 136 renal transplant patients received everolimus or continued CNI based therapy in de novo (day zero of transplantation), switch early (<6 months) and late (>6 months) groups. Patients were followed for 108 months. Results: 88 patients completed the 108-month study. At month 108, the mean mGFR was 33.94 (95% CI 42.67–57.25) ml/mt/1.73 m2 in de novo group, 49.19 (95% CI 55.29–64.99) ml/mt/1.73 m2 in early switch over, 25.95 (95% CI 34.34–7.38) ml/mt/1.73 m2 in late switch over and 34.54 (95% CI 41.57–54.06) ml/mt/1.73 m2 in CNI group. Patient and graft survival were comparable among groups (p = 0.698). There were 5 (13.1%) deaths in the de novo, 3 (10.3%) in early switch, 5 (21.7%) in late switch, and 6 (13%) in CNI group. Biopsy proven acute rejection rates were comparable among the groups: 28.9%, 20.7%, 26.7%, and 19.5% in de novo, early, late and CNI groups respectively (p = 0.057). Conclusion: Improvement in the renal function was observed in early switchover. Furthermore, patients with good renal function may benefit from conversion even at a late stage, and in patients with suboptimal renal function everolimus may not add any further benefit.

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