Renal Recovery After Conversion To An Everolimus-Based Immunosuppression In Early And Late Heart Transplant Recipients: A 12-Month Analysis

Objectives: Calcineurin inhibitor-induced nephrotoxicity reduces long-term patient survival after heart transplant. Proliferation signal inhibitors, in combination with or replacing calcineurin inhibitors, may preserve or improve renal function. We evaluated the effect of calcineurin inhibitor-reduction and withdrawal in everolimus-based immunosuppression on renal function after a heart transplant.Materials and Methods: Twenty-four patients with creatinine clearance < 1 mL/s (60 mL/min) were switched from tacrolimus and mycophenolate mofetil to low-dose tacrolimus/everolimus if their heart transplant was 1 year ago (group 1, n=13) and to everolimus/mycophenolate mofetil if their heart transplant was > 1 year ago (group 2, n=11). Serum creatinine levels and calculated creatinine clearance were analyzed up to 12 months after conversion.Results: The switch in immunosuppression was associated with a significant decrease/increase of serum creatinine/creatinine clearance in both groups between baseline and month 12 (group 1, creatinine, 221.0 +/- 70.7 to 159.1 +/- 44.2 pmol/L (2.5 +/- 0.8 to 1.8 +/- 0.5 mg/dL); creatinine clearance, 0.75 0.45 to 1.01 +/- 0.50 mL/s (45.1 +/- 26.7 to 60.5 +/- 29.7 mL/min) (P < .01 each); group 2, creatinine, 247.5 +/- 79.6 to 159.1 +/- 44.2 pmol/L (2.8 +/- 0.9 to 1.8 +/- 0.5 mg/dL), creatinine clearance, 0.57 +/- 0.23 to 0.93 +/- 0.33 mL/s (34.1 +/- 13.8 to 55.7 +/- 19.6 mL/min) [P <.05 each]) with no significant group difference in the creatinine and the creatinine clearance levels after switching. No acute rejections or deaths occurred during the 12-month follow-up. Four patients (36.4%) from group 2 and 1 patient (7.7%) from group 1 discontinued everolimus because of adverse events.Conclusions: Everolimus allows calcineurin inhibitor-reduction and withdrawal after heart transplantion resulting in improved renal function. However, adverse effects are common and lead to a high reconversion rate.