Replacement of calcineurin inhibitors with everolimus: Long-term impact in renal transplant recipients – A single center study

Abstract

BackgroundCalcineurin inhibitor withdrawal with introduction of mammalian target of rapamycin inhibitors is associated with improvement in the renal function. The aim of the study was to evaluate the long-term allograft function after a complete switch over to everolimus from CNI at different time points. MethodsSingle center prospective, observational, follow-up study, in which 136 renal transplant patients received everolimus or continued CNI based therapy in de novo (day zero of transplantation), switch early (<6 months) and late (>6 months) groups. Patients were followed for 108 months. Results88 patients completed the 108-month study. At month 108, the mean mGFR was 33.94 (95% CI 42.67–57.25)ml/mt/1.73m2 in de novo group, 49.19 (95% CI 55.29–64.99)ml/mt/1.73m2 in early switch over, 25.95 (95% CI 34.34–7.38)ml/mt/1.73m2 in late switch over and 34.54 (95% CI 41.57–54.06)ml/mt/1.73m2 in CNI group. Patient and graft survival were comparable among groups (p=0.698). There were 5 (13.1%) deaths in the de novo, 3 (10.3%) in early switch, 5 (21.7%) in late switch, and 6 (13%) in CNI group. Biopsy proven acute rejection rates were comparable among the groups: 28.9%, 20.7%, 26.7%, and 19.5% in de novo, early, late and CNI groups respectively (p=0.057). ConclusionImprovement in the renal function was observed in early switchover. Furthermore, patients with good renal function may benefit from conversion even at a late stage, and in patients with suboptimal renal function everolimus may not add any further benefit.