Journal of transplantation · 2026
Effects of Timing of Everolimus Transition on Renal Outcomes in Liver Transplant Recipients.
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Leick Mary, Belleau Hannah, McCashland Timothy
Аннотация
INTRODUCTION: Everolimus is often used in liver transplant recipients to minimize calcineurin inhibitors and their associated renal toxicity. This study aimed to evaluate the effects of the timing of everolimus transition on renal outcomes in adult liver transplant recipients.
MATERIALS AND METHODS: This retrospective subgroup analysis included adult isolated liver transplant recipients who transitioned to everolimus-containing immunosuppression at a single academic medical center between February 1, 2013, and May 31, 2018. Timing of everolimus transition from transplant determined patient groups: Group 1 (≤ 90 days), Group 2 (91-180 days), Group 3 (181-365 days), and Group 4 (> 365 days). Creatinine clearance at time of everolimus transition was compared to 1-month and 12-months post-transition using paired t-test analysis. Biopsy-proven acute cellular rejection was also assessed.
RESULTS: Eighty patients were included in this subgroup analysis. Group 1 (n = 25) and Group 2 (n = 20) had renal improvement at 1-month and 12-months post-transition (45.4 versus 69.6 and 61.6 mL/min, p = 0.004 and 0.035; 43.9 versus 60.7 and 57.5 mL/min, p = 0.02 and 0.008). Group 3 (n = 19) had renal improvement at 1 month but not at 12 months (52.6 versus 63.8 and 55.2 mL/min, p = 0.0004 and 0.43). Group 4 (n = 16) did not show renal improvement at 1 month or 12 months (54.5 versus 58.6 and 49.6 mL/min, p = 0.2 and 0.84). Biopsy-proven acute cellular rejection rate in each group was 40%, 20%, 10.5%, and 6.25%, respectively.
CONCLUSION: These data suggest that early transition to everolimus provides sustained renal function improvement in liver transplant recipients while late transition may not. Early transition poses a high risk of rejection. Timing of everolimus transition was observed to affect clinical outcomes and should be considered when adjusting immunosuppression.
MATERIALS AND METHODS: This retrospective subgroup analysis included adult isolated liver transplant recipients who transitioned to everolimus-containing immunosuppression at a single academic medical center between February 1, 2013, and May 31, 2018. Timing of everolimus transition from transplant determined patient groups: Group 1 (≤ 90 days), Group 2 (91-180 days), Group 3 (181-365 days), and Group 4 (> 365 days). Creatinine clearance at time of everolimus transition was compared to 1-month and 12-months post-transition using paired t-test analysis. Biopsy-proven acute cellular rejection was also assessed.
RESULTS: Eighty patients were included in this subgroup analysis. Group 1 (n = 25) and Group 2 (n = 20) had renal improvement at 1-month and 12-months post-transition (45.4 versus 69.6 and 61.6 mL/min, p = 0.004 and 0.035; 43.9 versus 60.7 and 57.5 mL/min, p = 0.02 and 0.008). Group 3 (n = 19) had renal improvement at 1 month but not at 12 months (52.6 versus 63.8 and 55.2 mL/min, p = 0.0004 and 0.43). Group 4 (n = 16) did not show renal improvement at 1 month or 12 months (54.5 versus 58.6 and 49.6 mL/min, p = 0.2 and 0.84). Biopsy-proven acute cellular rejection rate in each group was 40%, 20%, 10.5%, and 6.25%, respectively.
CONCLUSION: These data suggest that early transition to everolimus provides sustained renal function improvement in liver transplant recipients while late transition may not. Early transition poses a high risk of rejection. Timing of everolimus transition was observed to affect clinical outcomes and should be considered when adjusting immunosuppression.