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Effect of Everolimus on Body Composition; 1-Year After Kidney Transplantation

Weight gain, and especially visceral fat gain early after kidney transplantation has a worse outcome for metabolic disorder, graft function, and cardiovascular disease. The mammalian target of rapamycin (mTOR) is a regulator of metabolism and associated with obesity. The aim of this study is to investigate the role of mTOR inhibition in post-transplant obesity and body composition change. Method This is single-center cohort study. We analyzed 96 healthy adult kidney transplant patients and they were divided 2 groups; (1) Everolimus (EVR: introduced 3-months after transplantation), mPSL, MMF and reduced tacrolimus (TAC) (n=48) (2) mPSL, MMF and normal tacrolimus (n=48. These patients were transplanted before EVR was approved in Japan). In this analysis, change of body weight and visceral fat area at 3-12 months were compared between two groups by using logistic regression adjusted propensity score analysis. Vital signs, lipid and glucose profile, such as parameters of metabolic syndrome were also analyzed. Results Mean increase in body weight from 3 to 12 months after transplantation ware 2.45±7.98 kg (EVR group) and 2.35±5.42 kg (control group), and there was no significant difference. Visceral fat area was significantly increased in control group (13.34±28.51 cm2, EVR group: 8.34±16.93 cm2). EVR and reduced TAC significantly reduced the risk of abdominal obesity (visceral fat area≧100cm2) at 12-months after transplantation (Odds ratio; EVR: 0.14 95% confidence interval (CI), 0.03-0.67, Age: 1.06 95% CI, 1.01-1.02, pre-transplant abdominal obesity: 16.50 95% CI, 3.88-70.27). There were no significant differences about kidney function, glucose metabolism and occurrence of metabolic syndrome between two groups. Dyslipidemia was highly occurred in EVR group. Conclusion EVR with reduced TAC regimen had a possibility to attenuate visceral fat gain early after kidney transplantation without graft dysfunction. There was no significant effect for metabolic syndrome and impaired glucose metabolism. Further analysis is required.