Conversion From Steroid to Everolimus in Maintenance Kidney Transplant Recipients With Posttransplant Diabetes Mellitus.

Abstract

Although steroid withdrawal has been attempted to ameliorate various complications in kidney transplant recipients, a steroid-sparing strategy has more frequently led to acute rejection. We investigated the use of everolimus to safely overcome steroid withdrawal in kidney transplant recipients with posttransplant diabetes mellitus under maintenance immunosuppressive therapy. A total of 75 de novo consecutive kidney transplant recipients received conventional immunosuppressive therapy comprising tacrolimus (trough level of 5 ng/mL), mycophenolate mofetil (1000 mg), and methylprednisolone (4 mg). Patients with posttransplant diabetes mellitus underwent simultaneous everolimus administration (trough level of 3-5 ng/mL) and steroid withdrawal at 1 to 15 months after transplant. Graft outcomes were compared between the everolimus and steroid groups. In the everolimus group, renal function and hemoglobin A1c levels at 12 months after administration were compared with values before everolimus administration. The mean posttransplant follow-up period in the everolimus (n = 25) and steroid (n = 50) groups was 672 and 747 days, respectively. All grafts survived in both groups, and biopsy-proven acute rejection rates did not significantly differ between the groups (16% vs 12%; P = .72). Furthermore, no acute rejection occurred after everolimus administration. In the everolimus group, hemoglobin A1c significantly declined at 9 months after everolimus administration (6.94% vs 6.53%; P = .047). In addition, both serum creatinine levels and estimated glomerular filtration rates in the everolimus group were stable for 12 months after everolimus administration. Steroid withdrawal using everolimus as maintenance immunosuppressive therapy for kidney transplant recipients may safely ameliorate posttransplant diabetes mellitus, achieve better glycemic control, and maintain stable renal function.