Evolution of donor specific antibodies and incidence of de novo donor specific antibodies in solid organ transplant recipients after switch to everolimus alone or associated with low dose of calcineurin inhibitors

Clinical Transplantation Evolution of donor specific antibodies and incidence of de novo donor specific antibodies in solid organ transplant recipients after switch to everolimus alone or associated with low dose of calcineurin inhibitors

Abstract

Background

Everolimus (EVR) is used in organ transplantation to minimize calcineurin-inhibitors (CNI). Some studies pointed out an increase in rejection and de novo donor specific antibodies (DSA) incidence in kidney transplant patients after switch to EVR and CNI withdrawal. The aims of our study were to determine the evolution of anti-HLA antibodies and the incidence of de novo DSA in transplant recipients after conversion to EVR.

Methods

Heart, lung, kidney and liver transplant recipients were included in a retrospective, monocentric case-control study. Anti-HLA antibodies were identified at transplantation, pre-switch, and at 3, 6 and 12 months post-switch.

Results

Conversion to EVR was performed about 6 years after the transplant and low dose CNI was maintained in 60% of patients. We found no statistical difference for rejection, evolution of preformed anti-HLA antibodies or de novo DSA, after conversion to EVR or not. Incidence of anti-class II DSA tended to increase at month 12 whatever the immunosuppressive regimen.

Conclusions

Late conversion to EVR appears to be safe and to not modify the natural evolution of anti-HLA antibodies in organ transplantation. As 60% of patients received EVR and low doses of CNI, it seems that such combinations could be used with a good outcome.

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http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12418

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