title: Renal function preservation with the mTOR inhibitor, Everolimus, after lung transplant.
abstract: Chronic kidney disease (CKD) is a common complication of calcineurin inhibitors (CNIs) in solid organ transplantation. Previous data suggest that the use of everolimus as an immunosuppressant drug leads to improvement in renal function. The aim of our study was to establish the effect of everolimus in combination with lower doses of CNIs on renal function among lung transplant recipients. Data regarding renal function and pulmonary function were collected from 41 lung transplanted patients in whom treatment was converted to a combination of everolimus with lower doses of CNIs. Patients transferred to everolimus and low dose CNIs showed an improvement in renal function. Patients who continued treatment with everolimus showed improvement in renal function, as opposed to patients who discontinued the treatment. Subjects without proteinuria at baseline showed a better improvement compared with subjects with proteinuria. The incidence of graft rejection did not increase. We concluded that a protocol that includes everolimus and lower doses of CNIs is effective for preserving renal function in lung transplant recipients with CKD. We also believe that an early implementation of everolimus, before proteinuria occurs or creatinine clearance is reduced, could lead to better outcomes.
authors.affiliation: Rabin Medical Center, Pulmonary Institute, Petach Tikva, Israel.
authors.forename: Sonia
authors.initials: S
authors.lastname: Schneer
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
authors.forename: Benjamin
authors.initials: B
authors.lastname: Fox
authors.forename: Viktoria
authors.initials: V
authors.lastname: Rusanov
authors.forename: Oren
authors.initials: O
authors.lastname: Fruchter
authors.forename: Dror
authors.initials: D
authors.lastname: Rosengarten
authors.forename: Ilana
authors.initials: I
authors.lastname: Bakal
authors.forename: Benjamin
authors.initials: B
authors.lastname: Medalion
authors.forename: Yael
authors.initials: Y
authors.lastname: Raviv
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D051437:Renal Insufficiency / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus
keywords: creatinine clearance; everolimus; lung; mammalian target of rapamycin inhibitors; renal failure; transplant