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Clinical Experience of Conversion from Antimetabolites with Standard Exposure Tacrolimus to Everolimus with Tacrolimus Minimization in Stable Kidney Transplanted Recipients

Introduction The use of everolimus (EVE) with tacrolimus (TAC) minimization as de novo or as maintenance therapy, is increasingly widespread with good results in renal function. The aim of the study was to describe our clinical experience of conversion from antimetabolites (MMF) with standard exposure TAC to EVE with TAC minimization in stable kidney transplanted recipients. Patients and Methods We studied 229 kidney transplants performed consecutively from 07/01/2011 to 12/31/2016. 57 (24,89%) kidney recipients converted from MMF to EVE with TAC minimization was performed. The recipients had stable renal function and no proteinuria. Results Of the 57 patients, 64.9% were male. The mean age was 57.19 ± 15.52 years. The median time from transplant to conversion was 6 months (IQR 2.25-13). The conversion was due to: viral infection 25 (44%), neoplasia 11 (19.3%), nephrotoxicity induced by calcineurin inhibitors 2 (3.5%), indication of the clinician 15 (26.3%) and diarrhea 4 (7%). Renal function remained stable with a mean glomerular filtration rate estimate by MDRD-4 equation from 38.86 ± 13.17 ml/min/1,73 m2 at baseline to 39.21 ± 14.07 at the end of the study (not significant). We observed a significant increase in proteinuria from 0.19 mg/day (IQR 0.13, 0.34) at baseline to 0.28 mg/day (IQR 0.08, 0.60) at the end of the study (p <0.023). Significantly lower TAC concentrations were observed at the end of the study (p <0.0001). A significant increase in HDL (p <0.013) and an increased use of statins and Inhibitors of the Renin-Angiotensin-Aldosterone System (IRAAS) was observed at the end of the study. Treatment with EVE was stopped due to adverse events in 8.9% patients (proteinuria in 60%, lymphocele in 20% and pancytopenia in 20%). No patient had acute rejection after conversion. Conclusions In our experience, conversion to EVE is a good option in selected patients. It is well tolerated and allows TAC minimization without deterioration in renal function. Increased proteinuria that requires increased use of IRAAS, was observed.