PMID- 29631750
OWN - NLM
STAT- MEDLINE
DCOM- 20180828
LR  - 20180828
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 50
IP  - 4
DP  - 2018 May
TI  - Steroid Withdrawal Using Everolimus in ABO-Incompatible Kidney Transplant
      Recipients With Post-Transplant Diabetes Mellitus.
PG  - 1050-1055
LID - S0041-1345(18)30096-4 [pii]
LID - 10.1016/j.transproceed.2018.01.028 [doi]
AB  - BACKGROUND: The effectiveness of everolimus (EVR) for ABO-incompatible (ABOi)
      kidney transplantation is unknown. We evaluated outcomes of conversion from
      steroid to EVR in ABOi kidney transplant recipients. METHODS: We performed a
      retrospective observational cohort study of 33 de novo consecutive adult ABOi
      living donor kidney transplant recipients. Desensitization was performed using 0 
      to 4 sessions of plasmapheresis and 1 to 2 doses of 100 mg rituximab according to
      the anti-A/B antibody titer. ABOi recipients were administered a combination of
      tacrolimus, mycophenolate mofetil, and methylprednisolone. Diabetic patients were
      converted from methylprednisolone to EVR at 1 to 15 months post-transplantation
      to prevent diabetes progression. Graft outcomes, hemoglobin A1c (HbA1c) levels,
      and cytomegalovirus infection rates were compared between the EVR (n = 11) and
      steroid (n = 22) groups. RESULTS: Mean postoperative duration was 814 and 727
      days in the EVR and steroid groups, respectively (P = .65). Between the 2 groups,
      graft survival rate (100% vs 95.5%, P > .99), acute rejection rate (9.1% vs
      18.2%, P = .64), and serum creatinine levels (1.46 mg/dL vs 1.68 mg/dL, P = .66) 
      were comparable. Although HbA1c levels were elevated in the steroid group (5.47%,
      5.87%; P = .003), no significant deterioration was observed in the EVR group
      without additional insulin administration (6.10%, 6.47%; P = .21).
      Cytomegalovirus infection rate was significantly lower in the EVR group than in
      the steroid group (18.2% vs 63.6%, P = .026). CONCLUSION: Conversion from steroid
      to EVR in ABOi kidney transplant recipients maintained excellent graft outcomes
      and avoided diabetes progression and cytomegalovirus infection.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Nanmoku, K
AU  - Nanmoku K
AD  - Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital,
      Shimotsuke, Japan. Electronic address: nan.nan.mock@gmail.com.
FAU - Shinzato, T
AU  - Shinzato T
AD  - Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital,
      Shimotsuke, Japan.
FAU - Kubo, T
AU  - Kubo T
AD  - Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital,
      Shimotsuke, Japan.
FAU - Shimizu, T
AU  - Shimizu T
AD  - Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital,
      Shimotsuke, Japan.
FAU - Kimura, T
AU  - Kimura T
AD  - Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital,
      Shimotsuke, Japan.
FAU - Yagisawa, T
AU  - Yagisawa T
AD  - Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital,
      Shimotsuke, Japan.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20180407
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Steroids)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 9HW64Q8G6G (Everolimus)
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Blood Group Incompatibility
MH  - Cohort Studies
MH  - Cytomegalovirus Infections/epidemiology/etiology
MH  - *Diabetes Complications/epidemiology
MH  - *Diabetes Mellitus/drug therapy
MH  - *Drug Substitution/methods
MH  - Everolimus/*therapeutic use
MH  - Female
MH  - Graft Rejection/immunology
MH  - Graft Survival/drug effects
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Incidence
MH  - Kidney Transplantation/*adverse effects
MH  - Male
MH  - Middle Aged
MH  - Mycophenolic Acid/therapeutic use
MH  - Plasmapheresis
MH  - Retrospective Studies
MH  - Rituximab/therapeutic use
MH  - Steroids/therapeutic use
MH  - Tacrolimus/therapeutic use
EDAT- 2018/04/11 06:00
MHDA- 2018/08/29 06:00
CRDT- 2018/04/11 06:00
PHST- 2017/12/09 00:00 [received]
PHST- 2018/01/06 00:00 [revised]
PHST- 2018/01/30 00:00 [accepted]
PHST- 2018/04/11 06:00 [pubmed]
PHST- 2018/08/29 06:00 [medline]
PHST- 2018/04/11 06:00 [entrez]
AID - S0041-1345(18)30096-4 [pii]
AID - 10.1016/j.transproceed.2018.01.028 [doi]
PST - ppublish
SO  - Transplant Proc. 2018 May;50(4):1050-1055. doi:
      10.1016/j.transproceed.2018.01.028. Epub 2018 Apr 7.