Abstract

Introduction. Kidney transplant (KTx) with reduced functional reserve is more sensitive to the toxic effects of calcineurin inhibitors (CNI). Immunosuppressive therapy (IST) approach with m-TOR inhibitors in case of KTx from expanded criteria donors (ECD) leads to decreasing levels of cyclosporine (CsA) in the blood. Despite the presence of international pilot studies we do not have yet clear recommendation as to combination of CsA and Everolimus. In this article, we presented 5-year results of the fi rst Russian experience of systematic administration of Everolimus as a basic IST in KTx from ECDs.Materials and methods.The group of recipients (n = 41) having received bilateral kidney transplants from the same ECDs was analyzed. Comparison group (n = 19) received standard IST consisting of CsA, MMF and steroids. Study group included 22 recipients who received kidneys from the same ECDs and IST based on early (starting from the 90th day after transplantation) conversion from MMF to Everolimus – 1.5 mg/day (target concentration – 3–6 ng/mL). Simultaneously with the administration of Everolimus, dosing of Neoral dropped immediately by 50%, and then, in accordance with the target concentration (C0 30–50 ng/mL). Dosage of steroids in patients of the study group was gradually minimized.Results.Both groups were comparable in terms of serum creatinine level and glomerular fi ltration rate (GFR) up to 3 months after transplantation. As a result of the introduction of a new IST scheme in the study group, serum creatinine level in 60 months after KTx was 149.27 ± 42.68 μmol/L, in the comparison group – 209.87 ± 39.56 μmol/L; р < 0.05. In the control group GFR reduced to 27.50 ± 7.39 mL/min/1.73 m2, in the study group it was 46.21 ± 15.17 mL/min/1.73 m2, p < 0.05.Conclusion.Early administration of Everolimus is strongly recommended in all cases of ECD KTx. This approach helps minimize CNI nephrotoxicity, provides the prevention of chronic allograft nephropathy, enables the stable renal function, and contributes to the survival of renal transplant recipients.

Highlights

  • Kidney transplant (KTx) with reduced functional reserve is more sensitive to the toxic effects of calcineurin inhibitors (CNI)

  • We presented 5-year results of the first Russian experience of systematic administration of Everolimus as a basic Immunosuppressive therapy (IST) in KTx from expanded criteria donors (ECD)

  • Both groups were comparable in terms of serum creatinine level and glomerular filtration rate (GFR) up to 3 months after transplantation

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Summary

ТРАНСПЛАНТАЦИЯ ОРГАНОВ

Увеличение доли трансплантатов, полученных от доноров с расширенными критериями (ДРК), ставит вопрос об оптимизации схем иммуносупрессивной терапии (ИСТ). Были исследованы результаты пересадок контралатеральных почек (n = 41), полученных от ДРК, из числа этих реципиентов была сформирована группа сравнения (n = 19), пациенты которой получали стандартную ИСТ (ЦсА, микофенолаты, стероиды), и исследуемая группа (n = 22), пациенты которой получили контралатеральную почку и иммуносупрессию, с ранней (начиная с 90-го дня после ТП) конверсией от ММФ на эверолимус в дозе 1,5 мг/сут (целевая концентрация – 3–6 нг/мл). В результате введения новой схемы ИСТ в исследуемой группе к 60 месяцам после ТП креатинин составил 149,27 ± 42,68 мкмоль/л, в группе сравнения – 209,87 ± 39,56 мкмоль/л; р < 0,05. Ранняя конверсия на эверолимус показана в случаях Тх почек, полученных от ДРК.

Introduction
ПАЦИЕНТЫ И МЕТОДЫ
Findings
Donors characteristics in the study
Full Text
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