Conversion to everolimus in a patient with arterial hypertension and recurrent cutaneous neoplasia--a case report.
Calcineurin inhibitors (CNIs) are frequently associated with side effects such as nephrotoxicity and hypertension, so CNI withdrawal from immunosuppressive regimens is desirable in certain cases. The proliferation signal inhibitors/mammalian target of rapamycin inhibitors everolimus and sirolimus may play an important role in achieving CNI withdrawal. Studies on sirolimus have shown that conversion from CNIs is associated with improvements in renal function and hypertension. A case report is presented of a renal transplant recipient who experienced hypertension and recurrent cutaneous neoplasia while receiving a ciclosporin (CsA)-based immunosuppressive regimen. After transplantation, the patient received full-dose CsA and prednisolone. After 7 years, the patient's serum creatinine increased from 1.9 mg/dl to 2.5 mg/dl, and mycophenolate mofetil (MMF, 1000 mg/day) was introduced, enabling the CsA dose to be reduced to 100 mg b.i.d. The patient also required resection of five cutaneous neoplastic lesions; this led to the decision to stop CsA and start treatment with everolimus 1.5 mg/day, which was increased to 3.0 mg/day to achieve target trough blood levels of 3 ng/ml. To avoid over-immunosuppression, the MMF dose was reduced to 500 mg/day. After conversion, the patient experienced a substantial improvement in blood pressure, from 175/85 mmHg to 155/70 mmHg. Serum creatinine levels decreased to 1.6 mg/dl, and there has been no recurrence of cutaneous neoplasia in 9 months of follow-up. Therefore, conversion to everolimus from CsA in a renal transplant recipient led to improvements in blood pressure and resolution of recurrent cutaneous neoplasia, with no evidence of rejection or changes in renal function.
Pascual
Julio
J
Servicio de Nefrologia, Hospital Ramón y Cajal, Carretera de Colmenar, Km9.100, 28034 Madrid, Spain. jpascual.hrc@salud.madrid.org
Fernández
Ana M
AM
Marcén
Roberto
R
Ortuño
Joaquín
J
D001794:Blood Pressure; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects / Q000276:immunology; D004359:Drug Therapy, Combination; D000068338:Everolimus; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000276:immunology; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced* / Q000276:immunology / Q000601:surgery; D011183:Postoperative Complications / Q000276:immunology / Q000517:prevention & control; D011239:Prednisolone / Q000627:therapeutic use; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000276:immunology / Q000601:surgery; D016896:Treatment Outcome; D028761:Withholding Treatment
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068338:Everolimus; D011239:Prednisolone; D003404:Creatinine; D009173:Mycophenolic Acid; D020123:Sirolimus