title: Conversion of stable ABO-incompatible kidney transplant recipients from mycophenolate mofetil with standard exposure calcineurin inhibitors (CNIs) to everolimus with very low exposure CNIs-a short-term pilot study.
abstract: BACKGROUND
  A recent report has demonstrated that as with mycophenolate mofetil (MMF), everolimus is capable of inhibiting human B-lymphocyte function and activation including B-lymphocyte proliferation, apoptosis, and immunoglobulin production in vitro. Everolimus may therefore be used as an immunosuppressant in ABO-incompatible kidney transplantation.
  
  
  METHODS
  A three-month pilot study was performed to examine the efficacy and safety of conversion of stable ABO-incompatible kidney transplant recipients from MMF with standard exposure calcineurin inhibitors (CNIs) to everolimus with very low exposure CNIs. Sixteen recipients were enrolled in the study. The patients without acute rejection by graft biopsy were switched from MMF to everolimus with CNI minimization. At three months after conversion, graft biopsies were performed to check for acute rejection and C4d deposition.
  
  
  RESULTS
  Conversion to everolimus with CNI minimization for three months did not induce acute rejection and C4d deposition in all of the ABO-incompatible kidney transplant recipients. A slight elevation of anti-A/B antibody titer occurred in our present study. Everolimus was associated with hyperlipidemia and edema.
  
  
  CONCLUSIONS
  These results demonstrated that short-term conversion from MMF to everolimus after one yr post-transplant may be a safe and effective alternate for ABO-incompatible kidney transplant recipients requiring temporary discontinuation of MMF.
authors: Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors: Junji
authors: J
authors: Uchida
authors: Yuichi
authors: Y
authors: Machida
authors: Tomoaki
authors: T
authors: Iwai
authors: Nobuyuki
authors: N
authors: Kuwabara
authors: Kazuya
authors: K
authors: Kabei
authors: Toshihide
authors: T
authors: Naganuma
authors: Norihiko
authors: N
authors: Kumada
authors: Hidenori
authors: H
authors: Kawashima
authors: Tatsuya
authors: T
authors: Nakatani
mesh_terms: D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility; D065095:Calcineurin Inhibitors; D004305:Dose-Response Relationship, Drug; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010865:Pilot Projects; D011379:Prognosis; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000017:ABO Blood-Group System; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D009173:Mycophenolic Acid; D020123:Sirolimus
keywords: ABO-incompatible; calcineurin inhibitor minimization; everolimus; kidney transplantation; mycophenolate mofetil