CALCINEURIN INHIBITOR WITHDRAWAL AND CONVERSION TO MAMMALIAN TARGET OF RAPAMYCIN INHIBITOR (EVEROLIMUS) IN PEDIATRIC KIDNEY TRANSPLANT PATIENTS AT A TERTIARY HOSPITAL IN THAILAND

摘要

Due to the potential toxicity of calcineurin inhibitors (CNIs), CNI sparing immunosuppressive regimens were developed to reduce CNI exposure and to improve long-term outcomes in pediatric kidney transplant patients. This study retrospectively reviewed the clinical outcomes of pediatric kidney transplant recipients that were switched from standard regimen (a CNI, a mycophenolic acid agent, and corticosteroids) by CNI withdrawal and conversion to everolimus [a mammalian target of rapamycin (mTOR) inhibitor]. Ten transplant recipients (7 males) were included. Mean age at conversion was 14.0 +/- 2.2 years; median time to conversion after transplantation was 0.48 years (range: 0.06-10.5); and, mean duration of CNI-free interval was 2.5 +/- 1.1 years. The major indication for CNI elimination in recipients with early conversion (= 6 months; n=5) and late conversion (6 months; n=5) was early adverse effects related to the CNI and chronic allograft nephropathy, respectively. After becoming CNI-free, most recipients had improved (n=5) or stable (n=4) kidney graft function. Three recipients had biopsy-proven acute rejection, and CNI therapy was resumed in 2 of those patients. No grafts were lost in this study. CNI withdrawal and conversion to everolimus is an alternative regimen for pediatric kidney transplant recipients, especially in those requiring early conversion due to adverse effects of CNI.