Everolimus as primary immunosuppression in kidney transplantation: experience in conversion from calcineurin inhibitors.
Transplantation
; 93(4): 398-405, 2012 Feb 27.
Article
em En
| MEDLINE
| ID: mdl-22245871
ABSTRACT
BACKGROUND:
We analyzed our clinical experience with everolimus (EVL) and identified prognostic factors for a successful conversion.METHODS:
Retrospective study of 220 kidney recipients consecutively converted to EVL with calcineurin inhibitor elimination. We studied risk factors for proteinuria at 1 year after conversion, decline in renal function, and graft survival.RESULTS:
Baseline creatinine clearance was 52.4±17.8 mL/min vs. 53.4±20.1 mL/min 1 year after conversion (P=0.150). Median proteinuria increased from 304 mg/day (interquartile range 160-507) to 458 mg/day (interquartile range 238-892; P<0.001). Risk factors for development of proteinuria ≥900 mg/day (P75) at 1-year postconversion were creatinine clearance less than 60 mL/min (odds ratio [OR] 3.37; 95% confidence interval [CI] 1.15-9.89), serum triglycerides ≥150 mg/day (OR 4.35; 95% CI 1.70-11.17), no treatment with prednisone (OR 3.04; 95% CI 1.22-7.59), baseline proteinuria ≥550 mg/day (OR 10.37; 95% CI 3.99-26.99), and conversion ≥3 years after transplant (OR 5.77; 95% CI 1.89-17.59). An interaction was observed between baseline proteinuria and time to conversion in patients with baseline proteinuria ≥550 mg/day, the risk of developing proteinuria ≥900 mg/day was 77.1% if they were converted after ≥3 years posttransplant. However, this risk was 29.8% in the subgroup converted before (P=0.02). Actuarial graft survival at 1 and 4 years postconversion was 98.2% and 86.5%, respectively. Baseline proteinuria ≥550 mg/day was a risk factor for graft loss in patients converted after the third year but not in patients converted before this time. EVL discontinuation rate was 24% in the first year postconversion.CONCLUSIONS:
Conversion to EVL and elimination of calcineurin inhibitors is safe. Success depends on not making late conversions and not converting patients with high baseline proteinuria.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Transplante de Rim
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Sirolimo
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Inibidores Enzimáticos
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Inibidores de Calcineurina
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Imunossupressores
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Transplantation
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Espanha