Asian Transplantation Week 2017
Kidney Transplantation
Steroid Withdrawal Using Everolimus in ABO-Incompatible Kidney Transplant Recipients With Post-Transplant Diabetes Mellitus

https://doi.org/10.1016/j.transproceed.2018.01.028Get rights and content

Highlights

  • We aimed to improve complications in ABO-incompatible kidney transplant recipients.

  • We evaluated outcomes of a new protocol using conversion from steroid to everolimus.

  • Steroid withdrawal using everolimus could avoid diabetes progression.

  • Steroid withdrawal using everolimus could suppress CMV infection.

  • Everolimus administration may contribute to improved patient and graft outcomes.

Abstract

Background

The effectiveness of everolimus (EVR) for ABO-incompatible (ABOi) kidney transplantation is unknown. We evaluated outcomes of conversion from steroid to EVR in ABOi kidney transplant recipients.

Methods

We performed a retrospective observational cohort study of 33 de novo consecutive adult ABOi living donor kidney transplant recipients. Desensitization was performed using 0 to 4 sessions of plasmapheresis and 1 to 2 doses of 100 mg rituximab according to the anti-A/B antibody titer. ABOi recipients were administered a combination of tacrolimus, mycophenolate mofetil, and methylprednisolone. Diabetic patients were converted from methylprednisolone to EVR at 1 to 15 months post-transplantation to prevent diabetes progression. Graft outcomes, hemoglobin A1c (HbA1c) levels, and cytomegalovirus infection rates were compared between the EVR (n = 11) and steroid (n = 22) groups.

Results

Mean postoperative duration was 814 and 727 days in the EVR and steroid groups, respectively (P = .65). Between the 2 groups, graft survival rate (100% vs 95.5%, P > .99), acute rejection rate (9.1% vs 18.2%, P = .64), and serum creatinine levels (1.46 mg/dL vs 1.68 mg/dL, P = .66) were comparable. Although HbA1c levels were elevated in the steroid group (5.47%, 5.87%; P = .003), no significant deterioration was observed in the EVR group without additional insulin administration (6.10%, 6.47%; P = .21). Cytomegalovirus infection rate was significantly lower in the EVR group than in the steroid group (18.2% vs 63.6%, P = .026).

Conclusion

Conversion from steroid to EVR in ABOi kidney transplant recipients maintained excellent graft outcomes and avoided diabetes progression and cytomegalovirus infection.

Section snippets

Subjects and Study Design

We performed a retrospective, observational, cohort study of 33 de novo consecutive adult ABOi living donor kidney transplant recipients who underwent transplantation at Jichi Medical University Hospital between January 2013 and April 2017. This study was conducted in accordance with the principles of the Declarations of Helsinki and Istanbul and approved by the institutional review board.

Immunosuppressive Therapy

All ABOi recipients received immunosuppressive therapy for induction with Tac (0.1 mg/kg/d), MMF (30

Patient Characteristics

Before transplantation, no significant differences were observed between the EVR and steroid groups in patient characteristics such as sex, age, dialysis duration, donor-specific antigen-positive rate, living unrelated donor rate, CMV IgG-positive rate, and anti-donor-A/B antibody rate (Table 1). Conversely, the glomerulonephritis rate as the primary cause of end-stage renal disease was significantly higher in the steroid group than in the EVR group because patients with glomerulonephritis were

Discussion

In the present study, we investigated the outcomes of steroid withdrawal using EVR in ABOi kidney transplant recipients to determine whether conversion from steroid to EVR reduces the incidence of PTDM and CMV infection. Our results indicate that this new immunosuppressive protocol using conversion from steroid to EVR is effective in improving PTDM and CMV infection in ABOi kidney transplant recipients.

Steroid withdrawal for kidney transplantation is an attractive protocol because it can avoid

References (23)

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    Lack of correlation between results of ABO-incompatible living kidney transplantation and anti-ABO blood type antibody titers under our current immunosuppression

    Transplantation

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  • Cited by (4)

    • Management of metabolic alterations in adult kidney transplant recipients: A joint position statement of the Italian Society of Nephrology (SIN), the Italian Society for Organ Transplantation (SITO) and the Italian Diabetes Society (SID)

      2020, Nutrition, Metabolism and Cardiovascular Diseases
      Citation Excerpt :

      We could not find any published reports on the effects of reducing the dose of tacrolimus, CsA or corticosteroids; replacing tacrolimus or CsA with MMF or azathioprine; reducing the dose or discontinuing a mTORi on PTDM. One small retrospective, non-controlled trial showed that switching patients with PTDM from methylprednisolone to everolimus on top of tacrolimus and MMF did not worsen HbA1c over time [45]. An extension of this trial showed a significant decrease in HbA1c levels 9 months after conversion from methylprednisolone to everolimus [46].

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