Evidence-based practice: Guidance for using everolimus in combination with low-exposure calcineurin inhibitors as initial immunosuppression in kidney transplant patients

• Published in: Transplantation reviews (Philadelphia, Pa.) Pa.), 2019-10, Vol.33 (4), p.191-199
• Main Authors: Pascual, Julio, Berger, Stefan P, Chadban, Steven J, Citterio, Franco, Kamar, Nassim, Hesselink, Dennis A, Legendre, Christophe, Eisenberger, Ute, Oppenheimer, Federico, Russ, Graeme R, Sommerer, Claudia, Rigotti, Paolo, Srinivas, Titte R, Watarai, Yoshihiko, Henry, Mitchell L, Vincenti, Flavio, Tedesco-Silva, Helio
• Format: Article
• Language: English
• Subjects: Everolimus; Guidelines; Kidney; mTOR inhibitor/mTORi; Surgery; Transplantation
• ISSN: 0955-470X; 1557-9816
• DOI: 10.1016/j.trre.2019.07.001

AbstractThe mammalian target of rapamycin (mTOR) inhibitor, everolimus, in combination with reduced-exposure calcineurin inhibitor (CNI), has been demonstrated in clinical trials to have comparable efficacy in low-to-moderate immunological risk kidney transplant recipients to the Standard of Care, mycophenolic acid (MPA) in combination with standard-exposure CNI. Current treatment guidelines consider mTOR inhibitors to be a second-line therapy in the majority of cases; however, given that everolimus-based regimens are associated with a reduced rate of viral infections after transplantation, their wider use could have great benefits for kidney transplant patients. In this evidence-based practice guideline, we consider the de novo use of everolimus in kidney transplant recipients. The main outcomes of our consideration of the available evidence are that: 1. Everolimus, in combination with reduced-exposure CNI and low dose steroids, is a suitable regimen for the prophylaxis of kidney transplant rejection in the majority of low-to-moderate immunological risk adult patients, with individualized management; 2. Induction with either basiliximab or rabbit anti-thymocyte globulin is an effective therapy for kidney transplant recipients when initiating an everolimus-based, reduced-exposure CNI regimen; and 3. An individualized approach should be adopted when managing kidney transplant recipients on everolimus-based therapy.