PowerPoint Slides for:Donor-Specific Anti-Human Leukocyte Antigens Antibodies, Acute Rejection, Renal Function, and Histology in Kidney Transplant Recipients Receiving Tacrolimus and Everolimus

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 m2, 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 m2, 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.