Long-Term Follow-Up of De Novo Use of mTOR and Calcineurin Inhibitors After Kidney Transplantation

Long-Term Follow-Up of De Novo Use of mTOR and Calcineurin Inhibitors After Kidney Transplantation

Author de Paula, Mayara Ivani Autor UNIFESP Google Scholar
Medina-Pestana, Jose Osmar Autor UNIFESP Google Scholar
Ferreira, Alexandra Nicolau Autor UNIFESP Google Scholar
Cristelli, Marina Pontello Autor UNIFESP Google Scholar
Franco, Marcello Fabiano Autor UNIFESP Google Scholar
Aguiar, Wilson Ferreira Autor UNIFESP Google Scholar
Tedesco-Silva, Helio Autor UNIFESP Google Scholar
Felipe, Claudia Rosso Autor UNIFESP Google Scholar
Abstract Background:Long-term efficacy and safety of de novo use of the mammalian target of rapamycin inhibitors (mTORi) have been evaluated primarily using registry data.Methods:This was a pooled retrospective analysis of data obtained from 10 prospective randomized trials in de novo kidney transplant recipients (n = 581) receiving calcineurin inhibitors (CNIs) combined with sirolimus (n = 329), everolimus (n = 128), or antimetabolites (n = 124).Results:There were no differences in patient (84.5 versus 80.9 versus 89.7%, P = 0.996), graft (65.4 versus 59.5 versus 73.1%, P = 0.868), and biopsy-confirmed acute rejection-free (78.1 versus 77.3 versus 79.0%, P = 0.976) survivals, respectively. The incidence of cytomegalovirus infection was lower (6 versus 3 versus 11%, P = 0.024) but treatment discontinuation was higher among patients receiving mTORi (66.0 versus 47.7 versus 31.5%, P < 0.001), respectively. At 5 years, median estimated glomerular filtration rate (49.6 versus 43.9 versus 53.2 mL/min, P = 0.006) was lower and the proportion of patients with proteinuria (53 versus 40 versus 23%, P < 0.001) was higher among patients receiving mTORi, respectively.Conclusions:The efficacy of de novo use of mTORi is comparable with that of antimetabolites in kidney transplant recipients receiving calcineurin inhibitor. Apart from the lower cytomegalovirus infection rate, the safety profile is unfavorable, showing higher treatment discontinuation rates and higher incidence of proteinuria.
Keywords sirolimus
everolimus
safety
tolerability
efficacy
xmlui.dri2xhtml.METS-1.0.item-coverage Philadelphia
Language English
Date 2016
Published in Therapeutic Drug Monitoring. Philadelphia, v. 38, n. 1, p. 22-31, 2016.
ISSN 0163-4356 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 22-31
Origin https://doi.org/10.1097/FTD.0000000000000227
Access rights Closed access
Type Article
Web of Science ID WOS:000368802800004
URI https://repositorio.unifesp.br/handle/11600/58644

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