title: Evolution of donor-specific antibodies (DSA) and incidence of de novo DSA in solid organ transplant recipients after switch to everolimus alone or associated with low dose of calcineurin inhibitors.
abstract: BACKGROUND
  Everolimus (EVR) is used in organ transplantation to minimize calcineurin inhibitors (CNI). Some studies pointed out an increase in rejection and de novo donor-specific antibodies (DSA) incidence in kidney transplant patients after switch to EVR and CNI withdrawal. The aims of our study were to determine the evolution of anti-HLA antibodies and the incidence of de novo DSA in transplant recipients after conversion to EVR.
  
  
  METHODS
  Heart, lung, kidney, and liver transplant recipients were included in a retrospective, monocentric case-control study. Anti-HLA antibodies were identified at transplantation, pre-switch, and at three, six, and 12 months post-switch.
  
  
  RESULTS
  Conversion to EVR was performed about six yr after the transplant, and low-dose CNI was maintained in 60% of patients. We found no statistical difference for rejection, evolution of preformed anti-HLA antibodies or de novo DSA, after conversion to EVR or not. Incidence of anti-class II DSA tended to increase at month 12 whatever the immunosuppressive regimen.
  
  
  CONCLUSIONS
  Late conversion to EVR appears to be safe and to not modify the natural evolution of anti-HLA antibodies in organ transplantation. As 60% of patients received EVR and low doses of CNI, it seems that such combinations could be used with a good outcome.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Emma
authors.initials: E
authors.lastname: Perbos
authors.forename: Estelle
authors.initials: E
authors.lastname: Juinier
authors.forename: Gwendaline
authors.initials: G
authors.lastname: Guidicelli
authors.forename: Claire
authors.initials: C
authors.lastname: Dromer
authors.forename: Pierre
authors.initials: P
authors.lastname: Merville
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Billes
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Taupin
authors.forename: Martine
authors.initials: M
authors.lastname: Neau-Cransac
mesh_terms: D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014019:Tissue Donors; D066027:Transplant Recipients
chemical_list: D065095:Calcineurin Inhibitors; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D000068338:Everolimus; D020123:Sirolimus
keywords: donor-specific anti-HLA antibodies; everolimus; mTOR inhibitor; minimization of calcineurin inhibitors