Elsevier

Transplantation Proceedings

Volume 47, Issue 8, October 2015, Pages 2364-2367
Transplantation Proceedings

13th Congress of the Catalan Transplantation Society
Kidney transplantation
Mammalian Target of Rapamycin Inhibitor Monotherapy: Efficacy in Renal Transplantation

https://doi.org/10.1016/j.transproceed.2015.09.006Get rights and content

Abstract

Background

Calcineurin inhibitors (CNI) have failed to improve long-term outcomes in renal transplantation. Anti-proliferative and anti-angiogenic effects of mammalian target of rapamycin inhibitors (m-TOR) without nephrotoxicity could improve long-term survival in selected transplant recipients.

Methods

We examined the evolution of 98 low–immunological risk renal transplant recipients on m-TOR monotherapy: 7 patients had induction without CNI and 91 were switched to m-TOR at 12 (p25–p75: 4–36) months after transplant.

Results

Median follow-up time was 46 (p25–p75: 28.5–72.0) months. Fifteen recipients dropped out of the study (15.3%): 8 patients (8.2%) had to change their immunosuppressive treatment because of complications and 7 (7.1%) lost their grafts as a result of chronic rejection (4 cases) or death with a functioning graft (3 cases). At the end of follow-up, 83 of 98 (84.6%) recipients remained on monotherapy. The rates of recipient and graft survivals were 100% and 98.8% at 2 years and 96.9% and 93.5% at 4 years; the percentages of patients on monotherapy after 2 and 4 years were 95.2% and 85.2%, respectively. Renal function improved significantly and proteinuria decreased but not significantly. Those patients switched to m-TOR significantly received more erythropoietin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and hypotensive agents than before starting m-TOR, whereas there were no significant changes related to the use of statins, body weight, or percentage of diabetic patients. No case of non-compliance was reported.

Conclusions

This study supports the safety and efficacy of monotherapy with m-TOR in selected renal transplant recipients.

Section snippets

Methods

This is an observational and prospective study carried out from 2001 to 2014 in a single renal transplant center.

Patients were evaluated immunologically for inclusion in the m-TOR monotherapy protocol.

The immunological evaluation consisted of:

  • •

    Measuring donor-specific antibodies (DSA) with the use of microsphere cytometry (Luminex).

  • •

    Evaluation of lymphocyte activity: production of ATP in cultures of T-lymphocytes and CD4+ activated by PHA mitogen (ImmuKnow CyleX).

Patients were enrolled in the

Results

The study population consisted of 98 recipients, 56 men and 42 women with a mean age of 56.0 years (95% CI: 53.8–58.2). Age and sex of recipients and their donors are shown in Table 1. Sirolimus was the m-TOR in 74 cases and everolimus in 24 patients.

Only 7 patients had received induction immunosuppression therapy without CNI, consisting of anti-CD25/thymoglobulin, m-TOR, mycophenolate mofetil (MMF), and prednisone, whereas the remaining 91 were switched to m-TOR at 12 months (p25–p75: 4–36

Discussion

A high degree of discontinuation of m-TOR is observed because of its side effects [14]. Patients in our study had a 100% rate of adherence to treatment, since all patients in the protocol had already received m-TOR with good tolerance.

At the end of follow-up, 15 recipients had dropped out of the study (15.3%), 8 of them without losing their grafts, and all of them have been on the protocol for a long period, at least 16 months (Table 2).

Proteinuria was the side effect responsible for the

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This work was supported by Pfizer Spain.

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