Early, abrupt conversion of de novo renal transplant patients from cyclosporine to everolimus: results of a pilot study.
In a single-center study, 20 kidney transplant patients without prior rejection were abruptly converted from cyclosporine to everolimus at seven wk post-transplant. All patients received basiliximab induction with maintenance enteric-coated mycophenolate sodium and corticosteroids. Biopsy-proven acute rejection had occurred in three of 20 patients (15.0%) by the end of week seven post-conversion. All episodes were mild and reversible, with subsequent recovery of renal function. Calculated glomerular filtration rate (GFR) improved significantly (51 +/- 11 mL/min at time of conversion, 58 +/- 12 mL/min at week seven post-conversion, 57 +/- 17 mL/min at month six post-conversion; p = 0.001). No patient developed proteinuria in the nephrotic range. Twenty-two adverse events were reported in 10 patients, three of which had a suspected relationship to everolimus. Mean leukocyte and platelet count decreased significantly, and triglyceride level increased. This study suggests that kidney transplant patients without prior rejection can be converted abruptly from cyclosporine to everolimus at seven wk post-transplant, resulting in significantly improved renal function with no apparent increase, in risk of rejection and good tolerability.
Holdaas
H
H
Section of Nephrology, Medical Department, The National Hospital, Oslo, Norway. hallvard.holdaas@rikshospitalet.no
Bentdal
O
O
Pfeffer
P
P
Mjørnstedt
L
L
Solbu
D
D
Midtvedt
K
K
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000077552:Basiliximab; D016572:Cyclosporine / Q000008:administration & dosage*; D000068338:Everolimus; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage; D010865:Pilot Projects; D011183:Postoperative Complications; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D016572:Cyclosporine; D000077552:Basiliximab; D000068338:Everolimus; D009173:Mycophenolic Acid; D020123:Sirolimus