CLINICAL IMMUNOSUPPRESSION - KIDNEY LATE

C. Chiurchiu¹, H. Petrone², C. Balaguer³, P. Novoa⁴, F. Acosta⁵, C. González⁶, M. Arriola⁷, C. Agost carreño⁶, R.O. Schiavelli⁸, H. Trimarchi⁶, G. Soler pujol⁸, P.U. Massari^1
1Nephrology, for the Everolimus Argentinean Registry - Hospital Privado-Centro Médico de Córdoba, Córdoba/ARGENTINA, ²Kidney Transplant Unit - Crai Sur, CUCAIBA, La Plata/ARGENTINA, ³Nephrology, for the Everolimus Argentinean Registry - Hospital Privado-Centro Médico de Córdoba, Mendoza/ARGENTINA, ⁴Servicio De Nefrología, Hospital Córdoba, Córdoba/ARGENTINA, ⁵Nephrology, for the Everolimus Argentinean Registry - Hospital Privado-Centro Médico de Córdoba, Rosario/ARGENTINA, ⁶Nephrology, for the Everolimus Argentinean Registry - Hospital Privado-Centro Médico de Córdoba, Buenos Aires/ARGENTINA, ⁷Nephrology, for the Everolimus Argentinean Registry - Hospital Privado-Centro Médico de Córdoba, Santa Fé/ARGENTINA, ⁸Buenos Aires, Hospital Argerich, Buenos Aires/ARGENTINA

Body: Introduction: Proliferation signal inhibitors have been introduced with the aim of reducing nephrotoxicity. Time of introduction of this therapeutic class may be key for the achievement of satisfactory results. We report the results of a registry currently collecting data at 11 sites in Argentina from kidney transplant recipients using everolimus (EVL) in their immunosuppressive regimen. Material and Methods: This is a cross sectional analysis about the results with the use of EVL in daily clinical practice in maintenance renal transplant recipients. Patients were converted to EVL and CNI withdrawn due to kidney function decline, neoplasia or poor tolerability with other drugs. After conversion patients received EVL, mycophenolate and corticosteroids. Cusum plot of renal function vs post conversion time was used to separate two groups regarding renal function evolution, the cut point was localized at 24 months. Mean time post transplant at conversion was: 11.2±5 months for those considered as early conversion (EC, n=19) and 98.3±57 months for those considered as delayed conversion (DC, n=70). Mean follow up time at the analysis was 452±275 days for EC and 482±266 days for DC. Renal function and urinary protein data are reported at month six prior to conversion (-6mCT), conversion time (CT) and last visit follow up (LVFU). Safety variables are reported at LVFU. Results: Mean age at conversion time was 39.2±14.5 years for EC and 39.5±14.8 years for DC, proportion of male sex was 60 for EC and 62 for DC. Serum creatinine (-6mCT, CT and LCFU) was 1.76, 1.80 and 1.59 mg/dl (p <0.001) for EC and 1.66, 1.73 and 2.06 mg/dl for DC. Estimated glomerular filtration rate by MDRD (-6mCT, CT and LVFU) was 47.53, 47.59 and 51.18 ml/min for EC (p =0.03) and 48.46, 46.46 and 46.20 ml/min for DC. Protein creatinine ratio (-6mCT, CT and LVFU) was 0.28, 0.28 and 0.27 for EC (p=ns) and 0.35, 0.43 and 1.02 for DC (p<0.002). Infections rate was 4/19 for EC and 5/70 for DC. Reported rejection episodes after conversion were for EC 1/19 and for DC 2/70. Five allograft losses were reported in the DC group, none in EC. Six deaths were registered in the DC conversion group and none for EC. Conclusion: In this observational cross sectional analysis improvement in renal function was observed in the group of patients who withdrew CNI and introduced EVL during the first two years post transplantation.

Disclosure: All authors have declared no conflicts of interest.