Variances in the Use of Everolimus in Kidney Transplantation: A 2-Year Registry of Everyday Practice.

BACKGROUND: Everolimus (EVL)-based immunosuppressive strategies may permit the reduction of calcineurin inhibitors (CNI) and their side effects, while offering a safe and efficient treatment. Our aim was to describe our experience with EVL in everyday practice and provide information for its optimal utilization. METHODS: Prospective, multicenter study of 181 kidney transplant recipients treated with EVL as part of their immunosuppressive regimen, with a follow-up of 24 months. We studied demographic data, transplant characteristics, clinical information, drugs used, serum creatinine, estimated glomerular filtration rate (eGFR), rejection episodes, and adverse events. RESULTS: In total, 181 renal transplant recipients were included. Of these, 30 (16.6%) received EVL de novo and 151 (83.4%) were converted; median time from transplantation to conversion was 10 (range, 1-312) months. Main reasons for conversion were prevention of interstitial fibrosis and tubular atrophy (23.9%), intolerance to immunosuppressants (11.1%), neoplasia (13.9%), nephrotoxicity (8.9%), and cytomegalovirus infections (8.3%). The eGFR values at baseline, months 12, and 24 were 46.4 ± 27.4 mL/min, 54.8 ± 22.9 mL/min, and 55.9 ± 26.5 ml/min, respectively. Two of 181 (1.1%) patients died, 5 of 181 (2.8%) lost their grafts, 12 of 181 (6.6%) had an episode of acute rejection, 13 of 181 (7.2%) had ≥1 serious event and infection, and 85 of 181 (49.9%) had ≥1 nonserious adverse event or infection. Multivariate analysis showed that increased eGFR at month 24 was associated with lower donor age, shorter time from transplant to EVL introduction, and a baseline eGFR ≥40 mL/min. CONCLUSION: Through different strategies among centers, the inclusion of EVL improved renal function during the first 12 months.

Use of everolimus in renal transplant recipients: data from a national registry.

Proliferation signal inhibitors, such as everolimus, offer immunosuppression without the toxicity of calcineurin inhibitors. This descriptive and prospective study reports outcomes at 1 year and predictors of improved estimated glomerular filtration rate (eGFR) in 174 renal transplant recipients from a national registry of the use of everolimus. At 1 year after conversion, 48.85% of patients had improved eGFR compared with baseline. The mean time from transplantation to initiation of treatment with everolimus was 47.97 months, the median 22 (range, 0-312) months. The kidneys were from deceased donors in 120 patients (68.79%) and from living donors in 54 (31.21%); 35 (20.83%) were expanded-criteria donors. When comparing the baseline versus 12-month values of laboratory results, total cholesterol levels and platelet counts differed significantly-191.55 ± 43.92 mg/dL versus 204.52 ± 41.29 mg/dL (P < .05) and 213,411 ± 63,231/mm(3) vs 255,571 ± 59,153/mm(3), respectively (P < .05)-but remained within clinically controllable ranges. Glycemia, triglycerides, hematocrit, hemoglobin, and leukocytes remained stable. Logistic regression analysis of baseline variables showed that the only independent prognostic factor for improved eGFR at 1 year was the conversion of patients to everolimus within the first 12 months after transplantation (odds ratio, 2.17; 95% confidence interval, 1.15-4.10). In conclusion, regarding the effectiveness of everolimus in our subjects, the only predictor of improved eGFR identified at 1 year was conversion within 12 months after transplantation.

Trasplante renal ABO incompatible de dador vivo relacionado / ABO incompatible renal transplantation of related living donor

Se presenta un caso, que se suma a recientes y escasos ejemplos comunicados en la literatura extranjera, de un transplante exitoso de un dador de grupo sanguíneo B a un receptor de grupo sanguíneo 0. Se efectuó una preparación previa con esplenectomía, plasmaferesis, corticoides, ciclosporina y globulina antilinfocitaria que, de acuerdo a comunicaciones recientes serían factores determinantes del éxito del trasplante. En casos excepcionales, el trasplante entre grupos ABO incompatibles no debe ser siempre contra-indicado

Trasplante renal ABO incompatible de dador vivo relacionado / ABO incompatible renal transplantation of related living donor

Se presenta un caso, que se suma a recientes y escasos ejemplos comunicados en la literatura extranjera, de un transplante exitoso de un dador de grupo sanguíneo B a un receptor de grupo sanguíneo 0. Se efectuó una preparación previa con esplenectomía, plasmaferesis, corticoides, ciclosporina y globulina antilinfocitaria que, de acuerdo a comunicaciones recientes serían factores determinantes del éxito del trasplante. En casos excepcionales, el trasplante entre grupos ABO incompatibles no debe ser siempre contra-indicado (AU)