Abstract
In a 36-month, open-label, multicenter trial, 202 kidney transplant recipients were randomized at week 7 post-transplant to convert to everolimus or remain on cyclosporine: 182 were analyzed to month 36 (92 everolimus, 90 controls). Mean (SD) change in measured GFR (mGFR) from randomization to month 36 was 1.3 (14.0)mL/min with everolimus versus -1.7 (15.4)mL/min in controls (p=0.210).. In patients who remained on treatment, mean mGFR improved from randomization to month 36 by 7.9 (11.5)mL/min with everolimus (n=37) but decreased by 1.4 (14.7)mL/min in controls (n=62) (p=0.001). During months 12–36, death-censored graft survival was 100%, patient survival was 98.9% and 96.7% in the everolimus and control groups respectively, and 13.0% and 11.1% of everolimus and control patients, respectively, experienced mild biopsy-proven acute rejection. Protocol biopsies in a limited number of on-treatment patients showed similar interstitial fibrosis progression Donor specific antibodies were present at month 36 in 6.3% (2/32) and 18.0% (9/50) of on-treatment everolimus and control patients with available data (p=0.281). Adverse events were comparable, but discontinuation was more frequent with everolimus (33.7% versus 10.0%). Conversion from cyclosporine to everolimus at seven weeks post-transplant was associated with a significant benefit in renal function at three years when everolimus was continued.
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http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Ftri.12437
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