Conversion of stable ABO‐incompatible kidney transplant recipients from mycophenolate mofetil with standard exposure calcineurin inhibitors (CNIs) to everolimus with very low exposure CNIs–a short‐term pilot study

• DOI: 10.1111/ctr.12281
• Publication Date: 2013-12-12T05:04:52Z
• Authors: Junji Uchida; Yuichi Machida; Tomoaki Iwai; Nobuyuki Kuwabara; Kazuya Kabei; Toshihide Naganuma; Norihiko Kumada; Hidenori Kawashima; Tatsuya Nakatani
• Keywords: Graft Rejection; Male; Dose-Response Relationship, Drug; Calcineurin Inhibitors; Graft Survival; Pilot Projects; Middle Aged; Mycophenolic Acid; Kidney Function Tests; Prognosis; Kidney Transplantation; ABO Blood-Group System; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Blood Group Incompatibility; Humans; Kidney Failure, Chronic; Female; Everolimus; Immunosuppressive Agents; Follow-Up Studies; Glomerular Filtration Rate

AbstractBackgroundA recent report has demonstrated that as with mycophenolate mofetil (MMF), everolimus is capable of inhibiting human B‐lymphocyte function and activation including B‐lymphocyte proliferation, apoptosis, and immunoglobulin production in vitro. Everolimus may therefore be used as an immunosuppressant in ABO‐incompatible kidney transplantation.MethodsA three‐month pilot study was performed to examine the efficacy and safety of conversion of stable ABO‐incompatible kidney transplant recipients from MMF with standard exposure calcineurin inhibitors (CNIs) to everolimus with very low exposure CNIs. Sixteen recipients were enrolled in the study. The patients without acute rejection by graft biopsy were switched from MMF to everolimus with CNI minimization. At three months after conversion, graft biopsies were performed to check for acute rejection and C4d deposition.ResultsConversion to everolimus with CNI minimization for three months did not induce acute rejection and C4d deposition in all of the ABO‐incompatible kidney transplant recipients. A slight elevation of anti‐A/B antibody titer occurred in our present study. Everolimus was associated with hyperlipidemia and edema.ConclusionsThese results demonstrated that short‐term conversion from MMF to everolimus after one yr post‐transplant may be a safe and effective alternate for ABO‐incompatible kidney transplant recipients requiring temporary discontinuation of MMF.