title: Everolimus and Advagraf Ab Initio in Combined Liver and Kidney Transplant With Donor-Specific Antibodies: A Case Report.
abstract: Although donor-specific antibodies are regarded as a contraindication for kidney transplantation, the data available for combined liver and kidney transplantation (cLKTx) are scarce, and there is no established therapeutic approach for this category of transplant recipients. De novo use of everolimus and a reduced dose of calcineurin inhibitor reportedly provides excellent kidney function compared with a standard regimen containing a calcineurin inhibitor. This strategy, however, has been applied in only some recipient categories. Here we report a case of A highly sensitized male patient who underwent a cLKTx and received everolimus with low-dose tacrolimus (once-daily prolonged-release formulation) as ab initio immunosuppressive treatment. The pretransplant panel-reactive antibody estimate was 97%, and multiple anti-HLA antibodies were detected at the time of transplantation. Thus far, patient and allograft survival have reached 2 years, with the recipient remaining on a regimen of immunosuppression with everolimus and low-dose tacrolimus, with no episodes of rejection.
authors.affiliation: Liver and Kidney Transplant Centre, Policlinico "Tor Vergata", University of Rome "Tor Vergata", Rome, Italy. Electronic address: laura.tariciotti@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Tariciotti
authors.affiliation: Liver and Kidney Transplant Centre, Policlinico "Tor Vergata", University of Rome "Tor Vergata", Rome, Italy.
authors.forename: T M
authors.initials: TM
authors.lastname: Manzia
authors.affiliation: Liver and Kidney Transplant Centre, Policlinico "Tor Vergata", University of Rome "Tor Vergata", Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Sforza
authors.affiliation: Liver and Kidney Transplant Centre, Policlinico "Tor Vergata", University of Rome "Tor Vergata", Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Anselmo
authors.affiliation: Liver and Kidney Transplant Centre, Policlinico "Tor Vergata", University of Rome "Tor Vergata", Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tisone
mesh_terms: D000906:Antibodies / Q000276:immunology; D000961:Antilymphocyte Serum / Q000276:immunology; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D051799:Delayed Graft Function / Q000276:immunology; D004359:Drug Therapy, Combination; D000068338:Everolimus / Q000627:therapeutic use*; D006084:Graft Rejection / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000276:immunology; D016030:Kidney Transplantation / Q000379:methods*; D008099:Liver / Q000276:immunology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D066027:Transplant Recipients; D014181:Transplantation Immunology
chemical_list: D000906:Antibodies; D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D000068338:Everolimus; D016559:Tacrolimus