Complete switch to everolimus in long-term kidney transplants: evolution of the renal function.
BACKGROUND
The use of M-tor inhibitors plus withdrawal of anticalcineurins after 3 months of posttransplantation is usually linked to improvements in renal function. The long-term effects of substitution of anticalcineurinis by everolimus remain unknown. The aim in this study was to evaluate the evolution of renal function and the proteinuria after a complete switch of long-term functioning allograft patients to everolimus. We treated 30 renal transplanted patients with everolimus, at a mean time posttransplantation of 123.8 +/- 74.2 months. The 27 patients, including 17 treated with tacrolimus and 10 with cyclosporine, who were controlled for at least 6 months were included in this study. Seventeen of them were diagnosed to display chronic allograft nephropathy (CAN).


RESULTS
The patients with CAN showed a basal creatinine of 1.81 +/- 0.4; with after a year, 1.61 +/- 0.38; and after 2 years, 1.56 +/- 0.49 mg/dL (P < .05). No significant changes were observed among patients without CAN: 1.1 +/- 0.32, 0.97 +/- 0.15, and 0.97 +/- 0.15 mg/dL, respectively. In CAN patients, the protein/creatinine quotient was: basal = 0.30 +/- 0.13, one year = 0.63 +/- 0.68, and 2 years = 0.48 +/- 0.34. In the other patients the values were 0.2 +/- 0.07, 0.73 +/- 0.7, and 0.32 +/- 0.17, respectively, after a late switch to everolimus.


CONCLUSIONS
The improved renal function occurred mainly in patients with CAN. Patients who did not suffer from it showed a greater rise in proteinuria. Nevertheless, both groups experienced decreased proteinuria after 2 years.
Fernández
A
A
Nephrology Service, Hospital Ramón y Cajal, Madrid, Spain. afernandezr.hrc@salud.madrid.org
Marcén
R
R
Galeano
C
C
Caldés
S
S
Amezquita
Y
Y
Villafruela
J
J
Pascual
J
J
Burgos
J
J
Rodríguez-Mendiola
N
N
Ortuño
J
J
D000328:Adult; D000368:Aged; D002102:Cadaver; D065095:Calcineurin Inhibitors; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000473:pathology
D065095:Calcineurin Inhibitors; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068338:Everolimus; D003404:Creatinine; D020123:Sirolimus; D016559:Tacrolimus