title: Safety and efficacy of the early introduction of everolimus with reduced-exposure cyclosporine a in de novo kidney recipients.
abstract: BACKGROUND
  Everolimus and cyclosporine A (CsA) exhibit synergistic immunosuppressive activity when used in combination. We examined the safety and efficacy of the use of everolimus with a cyclosporine-sparing strategy in de novo renal transplant recipients.
  
  
  METHODS
  A comparative, parallel, randomized, open-label 1-year study has been performed in 148 patients from five transplant centers to compare the efficacy and tolerability of everolimus and reduced exposure CsA (the investigational group) or enteric-coated mycophenolate sodium and standard-exposure CsA (the control group) in combination with basiliximab and steroids. The eligible subjects were randomly assigned at 1 month after transplantation. Efficacy failure (biopsy-proven acute rejection, death, graft loss, or loss to follow-up), safety, and renal function were evaluated.
  
  
  RESULTS
  One graft loss has been reported in the control group and no patient death were reported in either group. The incidence of biopsy-proven acute rejection until 12 months after transplantation of the investigational group was 7.5%, compared to 11.1% of the control group (P=0.565). The mean estimated glomerular filtration rates of the investigational group at 12 months after transplantation was significantly higher (68.1 ± 16.8 ml/min/1.73 m(2)) than that of the control group (60.6 ± 15.8 ml/min/1.73 m(2); P=0.016). There was no significant difference (P>0.05) in the incidence of discontinuations and serious adverse events between the groups.
  
  
  CONCLUSIONS
  The results of this study provide the evidences that (1) the calcineurin inhibitor (CNI) minimization by the introduction of everolimus after 1-month posttransplantation keeps the incidences of acute rejection and additional risks as low as the conventional immunosuppression; (2) it allows minimizing CNI exposure, consequently reducing CNI nephrotoxicity and preserving renal function.
authors.affiliation: 1 Department of Surgery, Ajou University School of Medicine, Suwon, Korea. 2 Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 3 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 4 Department of Nephrology, Inje University School of Medicine, Busan, Korea. 5 Department of Nephrology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Chang-Kwon
authors.initials: CK
authors.lastname: Oh
authors.forename: Kyu Ha
authors.initials: KH
authors.lastname: Huh
authors.forename: Jongwon
authors.initials: J
authors.lastname: Ha
authors.forename: Yeong Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.forename: Yu Seun
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000077552:Basiliximab; D065095:Calcineurin Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D000068338:Everolimus; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011446:Prospective Studies; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage; D056910:Republic of Korea; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013256:Steroids / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D013256:Steroids; D016572:Cyclosporine; D000077552:Basiliximab; D000068338:Everolimus; D009173:Mycophenolic Acid; D020123:Sirolimus