title: New Recipes With Known Ingredients: Combined Therapy of Everolimus and Low-dose Tacrolimus in De Novo Renal Allograft Recipients.
abstract: BACKGROUND
  Calcineurin inhibitors (CNIs) are the cornerstones of immunosuppressive management in renal allograft recipients even though their nephrotoxicity may contribute to a reduced long-term graft survival. This has created a great interest in improving immunosuppressive strategies in the early post-transplantation period. Proliferation signal inhibitors (PSIs), such as everolimus, are promising alternatives, although their side effects may have a drawback in de novo renal transplant recipients, for instance, delaying renal function in the presence of renal ischemia/acute tubular necrosis and predisposing to lymphocele development.
  
  
  METHODS
  A retrospective study was developed to compare the combined therapy of low-dose tacrolimus and everolimus (study group) with mycophenolate mofetil/mycophenolic acid and standard-dose tacrolimus (control group) in the first 3 months post-transplantation. The study's end-points concerned renal graft function, proteinuria, incidence of biopsy-proven acute rejection, surgical complication rates, and incidence of new-onset diabetes after renal transplantation.
  
  
  RESULTS
  There was no more delayed graft function in the study group and graft function distribution was similar between groups. Median serum creatinine and eGFR were comparable as well as proteinuria levels. Generally, adverse events were rare in both groups and there were no significant statistical differences between them in terms of biopsy-proven acute rejection, surgical complication, and new-onset diabetes after renal transplantation rates.
  
  
  CONCLUSIONS
  Despite the slightly lower tendency for serum creatinine in the study group, renal allograft function wasn't statistically different between groups. Moreover, there weren't more metabolic or surgical complications in the study group. Everolimus may be a choice in tacrolimus-sparing strategies, but a larger study and a longer follow-up are still required.
authors.affiliation: Nephrology Department, CHUC, Coimbra, Portugal. Electronic address: tania.santos22@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Santos
authors.affiliation: Nephrology Department, CHUC, Coimbra, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Santos
authors.affiliation: Nephrology Department, CHUC, Coimbra, Portugal.
authors.forename: F
authors.initials: F
authors.lastname: Macário
authors.affiliation: Nephrology Department, CHUC, Coimbra, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Romãozinho
authors.affiliation: Nephrology Department, CHUC, Coimbra, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Alves
authors.affiliation: Nephrology Department, CHUC, Coimbra, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Campos
authors.affiliation: Urology and Kidney Transplantation Department, CHUC, Coimbra, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Mota
mesh_terms: D000293:Adolescent; D000368:Aged; D001706:Biopsy; D065095:Calcineurin Inhibitors / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D016559:Tacrolimus