Korean J Transplant.  2021 Mar;35(1):8-14. 10.4285/kjt.20.0043.

Early use of everolimus improved renal function after adult deceased donor liver transplantation

• Lee S
• Kim JM
• Kim S
• Rhu J
• Choi GS
• Joh JW

• KMID: 2514403
• DOI: http://doi.org/10.4285/kjt.20.0043

Abstract

Background
Tacrolimus (TAC) is a main therapy for liver transplantation (LT) patients, but it has side effects such as chronic nephrotoxicity that progressively aggravate renal function. The purpose of this study was to retrospectively compare the renal function between a TAC group and a combination of everolimus and reduced TAC (EVR-TAC) group after deceased donor liver transplantation (DDLT).
Methods
The study comprised 131 patients who underwent DDLT between January 2013 and April 2018 at our institution. They received TAC or EVR-TAC after DDLT. Everolimus (EVR) was introduced between 1 and 6 months after DDLT.
Results
Thirty-six of 131 patients (27.5%) received EVR-TAC. The incidence of chronic kidney disease (CKD; estimated glomerular filtration rate, <60 mL/1.73 m 2 ) in the EVR- TAC group was higher than in the TAC group (25% vs. 8.4%; P=0.019). Increasing serum creatinine (n=23, 63.9%) was the most common cause for adding EVR to treatment of the posttransplant patients. There were no statistical differences in acute rejection and CKD between the two groups. The TAC trough level was significantly lower in the EVRTAC group than in the TAC group, and the renal function of the EVR-TAC group was worse than that of the TAC group until 1 year after DDLT. However, the renal function of the EVRTAC group improved and became similar to that of TAC group at 3 years posttransplant.
Conclusions
The present study suggests that EVR should be introduced as soon as possible after DDLT to reduce exposure to high doses of TAC to improve the renal function.

Keyword

Renal insufficiency; Immunosuppression; Calcineurin inhibitors

Figure

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  Fig. 1 The risk for developing acute rejection (A) and chronic kidney disease (CKD) (B). TAC, tacrolimus; EVR-TAC, combination of everolimus and reduced tacrolimus; DDLT, deceased donor liver transplantation.

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  Fig. 2 Renal function change after deceased donor liver transplantation. (A) Estimated glomerular filtration rate (eGFR) and (B) serum creatinine. TAC, tacrolimus; EVR-TAC, combination of everolimus and reduced tacrolimus. *P<0.05.

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  Fig. 3 TAC trough level. TAC, tacrolimus; EVR-TAC, combination of everolimus and reduced tacrolimus. *P<0.05.

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