Donor-Specific Anti-Human Leukocyte Antigens Antibodies, Acute Rejection, Renal Function, and Histology in Kidney Transplant Recipients Receiving Tacrolimus and Everolimus
Data
2017
Autores
Ferreira, Alexandra Nicolau 
Felipe, Claudia Rosso
Cristelli, Marina Pontello
Viana, Laila
Basso, Geovana
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Background: This analysis compared efficacy, renal function, and histology in kidney transplant recipients receiving tacrolimus (TAC) combined with everolimus (EVR) or mycophenolate (MPS). Methods: This was a retrospective analysis from a randomized trial in kidney transplant recipients who received a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG), TAC, EVR, and prednisone (PRED
r-ATG/EVR, n = 85), basiliximab (BAS), TAC, EVR, and PRED (BAS/EVR, n = 102) or BAS, TAC, MPS, and PRED (BAS/MPS, n = 101). We evaluated the incidence of de novo donor-specific anti-human leukocyte antigens antibodies (DSA) and histology on protocol biopsies at 12 months, and the incidence of acute rejection, estimated glomerular filtration rate (eGFR) and proteinuria at 36 months. Results: At 12 months, there were no differences in de novo DSA (6.4 vs. 3.4 vs. 5.5%) or in subclinical inflammation (2.0 vs. 4.8 vs. 10.2%), interstitial fibrosis/tubular atrophy (57.1 vs. 58.5 vs. 53.8%) and C4d deposition (2.0 vs. 7.3 vs. 2.6%). At 36 months, there were no differences in the incidence of treatment failure (19.0 vs. 27.7 vs. 27.7%, p = 0.186), first biopsy-proven acute rejection (9.5 vs. 21.8 vs. 16.8%, p = 0.073), and urine protein/creatinine ratios (0.53 +/- 1.05 vs. 0.62 +/- 0.75 vs. 0.71 +/- 1.24). eGFR was lower in the BAS/EVR compared to that in the BAS/MPS group (53.4 +/- 20.9 vs. 50.8 +/- 19.5 vs. 60.7 +/- 21.2 mL/min/1.73 m(2), p = 0.017) but comparable using a sensitive analysis (49.5 +/- 23 vs. 47.5 +/- 22.6 vs. 53.6 +/- 27.8 mL/min/1.73 m(2), p = 0.207). Conclusion: In this cohort, the use of EVR and reduced TAC concentrations were associated with comparable efficacy, renal function, and histological parameters compared to the standard-of-care immunosuppressive regimen. (C) 2017 S. Karger AG, Basel
r-ATG/EVR, n = 85), basiliximab (BAS), TAC, EVR, and PRED (BAS/EVR, n = 102) or BAS, TAC, MPS, and PRED (BAS/MPS, n = 101). We evaluated the incidence of de novo donor-specific anti-human leukocyte antigens antibodies (DSA) and histology on protocol biopsies at 12 months, and the incidence of acute rejection, estimated glomerular filtration rate (eGFR) and proteinuria at 36 months. Results: At 12 months, there were no differences in de novo DSA (6.4 vs. 3.4 vs. 5.5%) or in subclinical inflammation (2.0 vs. 4.8 vs. 10.2%), interstitial fibrosis/tubular atrophy (57.1 vs. 58.5 vs. 53.8%) and C4d deposition (2.0 vs. 7.3 vs. 2.6%). At 36 months, there were no differences in the incidence of treatment failure (19.0 vs. 27.7 vs. 27.7%, p = 0.186), first biopsy-proven acute rejection (9.5 vs. 21.8 vs. 16.8%, p = 0.073), and urine protein/creatinine ratios (0.53 +/- 1.05 vs. 0.62 +/- 0.75 vs. 0.71 +/- 1.24). eGFR was lower in the BAS/EVR compared to that in the BAS/MPS group (53.4 +/- 20.9 vs. 50.8 +/- 19.5 vs. 60.7 +/- 21.2 mL/min/1.73 m(2), p = 0.017) but comparable using a sensitive analysis (49.5 +/- 23 vs. 47.5 +/- 22.6 vs. 53.6 +/- 27.8 mL/min/1.73 m(2), p = 0.207). Conclusion: In this cohort, the use of EVR and reduced TAC concentrations were associated with comparable efficacy, renal function, and histological parameters compared to the standard-of-care immunosuppressive regimen. (C) 2017 S. Karger AG, Basel
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American Journal Of Nephrology. Basel, v. 45, n. 6, p. 497-508, 2017.