Abstract: SA-PO011
A Promising Novel Approach with Everolimus-Based Quadruple Maintenance Therapy in Kidney Transplant Recipients with Difficult-to-Treat Rejections
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Larsson, Pierre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Englund, Bodil, Sahlgrenska University Hospital, Gothenburg, Sweden
- Ekberg, Jana, Sahlgrenska University Hospital, Gothenburg, Sweden
- Felldin, Marie, Sahlgrenska University Hospital, Gothenburg, Sweden
- Broecker, Verena, Sahlgrenska University Hospital , Gothenburg, Sweden
- Mjörnstedt, Lars, Sahlgrenska University Hospital, Gothenburg, Sweden
- Baid-Agrawal, Seema, Sahlgrenska University Hospital, University of Gothenburg, Gothenburrg, Sweden
Background
Chronic rejections and treatment-resistant acute rejections are difficult to treat and lead to progressive loss of graft function in kidney transplant recipients (KTR). Here we review our experience with a novel approach to treat such rejections by adding everolimus, an inhibitor of mammalian target of rapamycin (mTOR) as a “rescue therapy” to the conventional triple maintenance therapy (prednisolone + mycophenolate mofetil + calcineurin inhibitor).
Methods
We analysed in detail electronic medical charts of 34 KTR who received everolimus-based quadruple therapy for biopsy-proven chronic rejections or treatment-resistant acute rejections between 2011-2017. A response to treatment was defined as an improvement/stabilization in the graft function (eGFR slope/year ≥1 ml/min/1.73m2/year).
Results
The results are summarized in the table below. Stabilization in graft function (eGFR) was seen at 48 months after treatment (table + figure), more so in acute as compared to chronic rejection subgroup. Treatment was stopped in 10 patients due to adverse events.
Conclusion
Everolimus-based maintenance quadruple therapy appears to be apromising novel approach for chronic rejections and treatment-resistant acute rejections, both of which are difficult to treat. Further randomized controlled studies are needed to confirm our findings.
Patients receiving quadruple therapy (N=34)
| 10 with acute rejection (2 acute cellular, 2 mixed cellular and antibody-mediated) 24 with chronic rejection (7 chronic cellular, 6 chronic antibody-mediated, 11 mixed) | |
| Age in years (mean ± SD) | 44.5 ± 18.5 |
| Gender (% males) | 53% |
| Time from transplant to quadruple therapy in months (mean ± SD) | 28.4 ± 31 |
| Duration of treatment (mean ± SD) | 29.7 ± 18.9 |
| Response to treatment | 14/34 (41%) |
| eGFR in ml/min/1.73m2, at baseline vs 48 months in all patients, acute and chronic subgroups, respectively (mean ± SD) | 37.1 ± 19.2 vs 40.9 ± 16.8, 35.9 ± 8.8 vs 44.5 ± 23.1, 43.0 ± 19.0 vs 31.2 ± 15.3 (P=NS for all) |
| Patient and graft survival at 6 years after start of treatment (Kaplan-Meier) | 77% and 51%, respectively. Not significantly different between the acute and chronic subgroups |