Early Switch to Mammalian Target of Rapamycin Inhibitors Is a Sustainable Treatment Approach in Renal Transplant Recipients: 7-Year Results

Abstract

Objective: The aim of this study was to investigate the safety and sustainability of mammalian target of rapamycin inhibitor (m-TORi)-based treatment protocols in renal transplant patients. Methods: We retrospectively evaluated a total of 206 patients who were switched to low-dose calcineurin inhibitors (CNI)+ m-TORi or mycophenolate mofetil (MMF)+ m-TORi treatment protocols in the first 3 months of renal transplantation between January 2010 and August 2011 in our center. Demographic and laboratory features of the patients were recorded. Results: Of the patients included in the study, 89 (43.2%)were female and 117 (56.8%)were male. The mean age was 41.9 ± 13.8 years. Panel reactive antibody was negative in 95% of the recipients. One hundred thirty-four (65%)patients received anti-thymocyte globulin induction therapy. Initially, 108 patients were treated with cyclosporine and 98 (47.6%)were treated with tacrolimus-based regimens. One hundred thirty-five patients (65.5%)were switched to low-dose CNI + m-TORi and 71 patients (34.5%)were switched to MMF + m-TORi. The mean switching time was 3 months. At the end of the study, 161 patients (78.2%)were still continuing the m-TORi treatment protocol and 45 patients (21.8%)could not continue for various reasons (11.4% proteinuria, 5.5% edema, 2.9% acute rejection, 1% acne + oral aphthae, 1% neuropathy). The biopsy-proven acute rejection rate was 4.5% (n = 9). The mean duration of sustainability of m-TORi treatment protocol was 84.15 ± 6.79 months. Mean serum creatinine of patients who were still continuing m-TORi was 1.42 ± 1.09 mg/dL. Conclusion: Switching to m-TORi in the early posttransplant period is a safe and sustainable treatment approach. © 2019 Elsevier B.V., All rights reserved.