FIRST RUSSIAN EXPERIENCE OF EARLY CONVERSION TO EVEROLIMUS IN THE KIDNEY TRANSPLANTATION FROM EXPANDED CRITERIA DONORS: A SUMMARY OF 5-YEAR OBSERVATION

Abstract

Introduction. Kidney transplant (KTx) with reduced functional reserve is more sensitive to the toxic effects of calcineurin inhibitors (CNI). Immunosuppressive (IST) approach included m-TOR inhibitors in case of KTx from the ECD lead to decreasing levels of cyclosporine (CsA) in the blood. Despite of presence international pilot studies we having not yet strong recommendation for real combination of CsA and Everolimus. In this article we presented 5-yeras results of the first Russian experience of systematic use Everolimus as basic IST in KTx from ECDs. Patients and methods. The group of recipients (n=41) was formed during the operation; received a bilateral kidney transplants from the same ECDs. Comparison group (n=19) received standard IST consisting of CsA, MMF and steroids. Study group included 22 recipients who received an another kidney from the same ECD and IST, based on early (starting from the 90th day after transplantation) conversion from MMF to Everolimus-1.5mg/day (target concentration-3-6ng/mL). Simultaneously with the appointment Everolimus, dosing occurred immediately Neoral decrease by 50% and then, in accordance with the target concentration (C0-30-50ng/ml). Implementing a program of gradual minimization of the dose steroids in patients of the study group. Results. Both groups were comparable in terms of level of serum creatinine and glomerular filtration rate of up to 3 months after transplantation. As a result of the introduction of a new scheme of ICN in the study group, for the 60-month observation GFR study group was 46±15 ml/min/1.73m 2 , the control is reduced to 28±7 ml/min/1.73m 2 ;P<0.05. Conclusion. Early administration of Everolimus is strongly recommended in all cases of the use of grafts for KTx obtained from the ECDs. This approach helps to minimize of nephrotoxity of CNT, provides the prevention of chronical transplant nephropathy, the stable renal function, and contributes to the survival and renal transplant recipients.