title: Everolimus associated with low-dose calcineurin inhibitors, an option in kidney transplant recipients of very old donors.
abstract: BACKGROUND
  Despite potential renal and cardiovascular advantages of proliferation signal inhibitors, their de novo use in kidney transplantation (KT) from elderly donors (ED) is poorly documented. We retrospectively analyzed two consecutive cohorts of KT from ED: low-dose extended-release tacrolimus (Tac) was used from 2010 to 2012 and cyclosporine (Csa) was used from 2008 to 2010.
  
  
  METHODS
  Associated maintenance drugs were everolimus (Eve) and steroids. Outcomes were compared between groups over a 12-month follow-up. Fifty-six patients were analyzed in the Tac-Eve group and 54 in the Csa-Eve group.
  
  
  RESULTS
  There were no significant differences at baseline with the exception of older donors age in the Tac-Eve cohort (74 vs 71 years, P = .002). There were no deaths, primary non functions, or graft losses. Eight (14%) Tac-Eve and 15 (28%) Csa-Eve patients had delayed graft function (P = .10). Renal function was fairly stable over time (median cGFR 36-49 mL/min and 51-55 mL/min in single kidney transplantation and dual kidney transplantation patients, respectively) with no significant differences between groups at month 12. Surgical complications were infrequent and observed mostly in dual kidney transplantation recipients. Thirty-nine (70%) and 30 (56%) patients remained under their initial Tac-Eve or Csa-Eve regimen, respectively.
  
  
  CONCLUSIONS
  Induction with Thymoglobuline and maintenance with Eve and low-dose extended-release Tac and steroids is safe and effective in renal transplant from ED.
authors.affiliation: Kidney and Pancreas Transplantation Unit, Padua, Italy. Electronic address: lucrezia.furian@unipd.it.
authors.forename: L
authors.initials: L
authors.lastname: Furian
authors.affiliation: Kidney and Pancreas Transplantation Unit, Padua, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Silvestre
authors.affiliation: Kidney and Pancreas Transplantation Unit, Padua, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Vallese
authors.affiliation: Kidney and Pancreas Transplantation Unit, Padua, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Baldan
authors.affiliation: Kidney and Pancreas Transplantation Unit, Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Donato
authors.affiliation: Nephrology Unit, Padua, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bonfante
authors.affiliation: Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cavallin
authors.affiliation: Nephrology Unit, Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Marchini
authors.affiliation: Kidney and Pancreas Transplantation Unit, Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Rigotti
mesh_terms: D000368:Aged; D065095:Calcineurin Inhibitors / Q000008:administration & dosage*; D016572:Cyclosporine / Q000627:therapeutic use; D051799:Delayed Graft Function; D000068338:Everolimus; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013256:Steroids; D016559:Tacrolimus / Q000008:administration & dosage*; D014019:Tissue Donors; D066027:Transplant Recipients
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D000068338:Everolimus; D020123:Sirolimus; D016559:Tacrolimus