Abstract
Post-transplant renal dysfunction (RD) in Liver transplantation occurs 18% at 5 years, mainly due to calcineurin inhibitors (13 to 33%). Nephroprotective strategies include minimization and / or suspension of CNI or conversion to mTOR (everolimus). To evaluate the experience with everolimus in a liver transplant center in Colombia in post-transplant RD. A retrospective study of liver transplant recipients was performed between 2013 and 2020 with conversion to everolimus due to RD assessed by creatinine and eGFR (MDRD4). The renal function evolution was evaluated at 6 and 12 months after conversion. The frequency of biopsy - proven acute rejection (BPAR) was determined. The adverse events associated with everolimus were documented. 301 transplants were performed between January 2013 and June 2020, 66 patients (21.9%) presented RD and required conversion to everolimus, 75% despite minimization of immunosuppression with CNI. Average age of 64 +/- 11.4 years and 54.5% men. 83.3% were in CHILD B and C, MELD score 17 at transplantation. 9 (13%) had hypertension, dyslipidemia 13 (19%) and Diabetes Mellitus 19 (28%). 11 patients (16%) had pretransplantation hepatorenal syndrome. The etiology was cryptogenic cirrhosis and NASH in 30%, hepatitis C 25% and autoimmunity 16%. Basiliximab induction 10.6%. At the time of conversion, creatinine was 1.5 +/- 0.44mg / dl, eGFR 47.7 +/- 18. At 6 months the creatinine was 1.27 +/- 0.2mg / dl and eGFR 58.4 +/- 14.5 maintaining the same clearance at 12 months without achieving additional recovery of glomerular filtration. There were 7 acute rejection episodes during conversion (10.6%), suspension of everolimus in 22% due to adverse events, mainly proteinuria. Postconversion dyslipidemia was 30%. Everolimus conversion in renal dysfunction is a strategy that allows stabilizing renal function and improving glomerular filtration in post-liver transplant patients, without a significant increase in BPAR or adverse events.
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