1. Everolimus as primary immunosuppression in kidney transplantation: experience in conversion from calcineurin inhibitors.
- Author
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Sánchez-Fructuoso AI, Ruiz JC, Calvo N, Rodrigo E, Perez-Flores I, Gómez-Alamillo C, Fernández-Pérez C, Arias M, and Barrientos A
- Subjects
- Adult, Aged, Cohort Studies, Enzyme Inhibitors adverse effects, Everolimus, Female, Follow-Up Studies, Graft Rejection epidemiology, Humans, Immunosuppressive Agents adverse effects, Male, Middle Aged, Prognosis, Proteinuria epidemiology, Renal Insufficiency epidemiology, Retrospective Studies, Risk Factors, Sirolimus adverse effects, Sirolimus therapeutic use, Treatment Outcome, Calcineurin Inhibitors, Enzyme Inhibitors therapeutic use, Immunosuppressive Agents therapeutic use, Kidney Transplantation immunology, Kidney Transplantation physiology, Sirolimus analogs & derivatives
- Abstract
Background: We analyzed our clinical experience with everolimus (EVL) and identified prognostic factors for a successful conversion., Methods: Retrospective study of 220 kidney recipients consecutively converted to EVL with calcineurin inhibitor elimination. We studied risk factors for proteinuria at 1 year after conversion, decline in renal function, and graft survival., Results: Baseline creatinine clearance was 52.4±17.8 mL/min vs. 53.4±20.1 mL/min 1 year after conversion (P=0.150). Median proteinuria increased from 304 mg/day (interquartile range 160-507) to 458 mg/day (interquartile range 238-892; P<0.001). Risk factors for development of proteinuria ≥900 mg/day (P75) at 1-year postconversion were creatinine clearance less than 60 mL/min (odds ratio [OR] 3.37; 95% confidence interval [CI]: 1.15-9.89), serum triglycerides ≥150 mg/day (OR 4.35; 95% CI: 1.70-11.17), no treatment with prednisone (OR 3.04; 95% CI: 1.22-7.59), baseline proteinuria ≥550 mg/day (OR 10.37; 95% CI: 3.99-26.99), and conversion ≥3 years after transplant (OR 5.77; 95% CI: 1.89-17.59). An interaction was observed between baseline proteinuria and time to conversion: in patients with baseline proteinuria ≥550 mg/day, the risk of developing proteinuria ≥900 mg/day was 77.1% if they were converted after ≥3 years posttransplant. However, this risk was 29.8% in the subgroup converted before (P=0.02). Actuarial graft survival at 1 and 4 years postconversion was 98.2% and 86.5%, respectively. Baseline proteinuria ≥550 mg/day was a risk factor for graft loss in patients converted after the third year but not in patients converted before this time. EVL discontinuation rate was 24% in the first year postconversion., Conclusions: Conversion to EVL and elimination of calcineurin inhibitors is safe. Success depends on not making late conversions and not converting patients with high baseline proteinuria.
- Published
- 2012
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