Use of everolimus as an alternative to calcineurin inhibitors in renal allograft recipients: A single South Indian center's experience

Abstract

Introduction: Chronic Renal Allograft Injury(CRAI) is the most important cause of chronic graft dysfunction and loss. Calcineurin inhibitors (CNI) have been the back bone for immunosuppressive therapy, but their adverse effects can directly contribute to CRAI and compromise long-term renal allograft outcomes. Hence alternatives for CNI's such as Everolimus have been tried. Methods: Thirty de novo renal transplant patients who are receiving Everolimus as a part of their immunosuppressive regimen were included in this study. These patients were followed up for a period of 2 years. The primary outcome measures were creatinine clearance and the proportion of patients with biopsy proven acute rejection (BPAR). Results: Twenty three out of thirty patients were men. Follow up after initiation of everolimus the minimum duration was 2 years and maximum was of 5 years. There was a statically significant reduction in creatinine and improvement in GFR after initiation of everolimus to 3rd month of therapy and the reduction was consistent throughout the period of follow up which is for 24 months. Incidence of biopsy proven acute rejection (BPAR) was 16.7 %. Incidence of NODAT (New Onset Diabetes After Transplant) was 16.7. None of the patients had nephrotic range of proteinuria. Conclusions: Our study clearly shows use of everolimus is associated with improvement and subsequent stabilisation of graft function after switching over from CNI, without increased risk of BPAR and is associated with fewer adverse effects. Everolimus is a promising agent which can be used as an alternative/ additive agent in our immunosuppressive drugs regimens.

Keywords

• Calcineurin inhibitors
• everolimus
• rejection
• renal transplant