CLINICAL IMMUNOSUPPRESSION - KIDNEY LATE

J.C. Ruiz, C. Robledo, E. Rodrigo, C. Gómez-alamillo, G. Fernández-fresnedo, M. Gago, C. Piñera, M. Arias
Nephrology, Valdecilla University Hospital, Santander/SPAIN

Body: INTRODUCTION: mTOR inhibitors have been associated with impaired fasting glucose (IFG) and a similar risk of new onset diabetes mellitus (NODAT) than calcineurin inhibitors (CNI) but this finding isbased only in the experience with Sirolimus. There are no reports on the influence of Everolimus (Eve) on glucose metabolism.

METHODS: We present our experience in renal transplant patients converted to Eve from a CNI-based regimen with respect to this issue. From 76 patients converted at our hospital between March/2005 andFebrero/2009, 60 patients without previous diabetes and a follow up of 12 months were retrospectively analyzed. 57 patients were under a CNI therapy (CyA 25 and Tcr 32) whereas 3 patients receivedAzathioprine without CNI before conversion. In all patients CNI were rapidly eliminated after conversion. Mean glucose and glycated hemoglobin (HbA1c) at 0, 30, 90 and 365 days after conversion ispresented as well as the cases of new onset DM after conversion was evaluated. The percentage of patients with IFG accoding to the ADA 2003 criteria was calculated at every moment.

RESULTS: Mean age of patients at conversion was 52.6y (71%males) and the mean conversion time after transplantation was 7.9y. Mean glucose at 0, 30, 90 and 365d was: 104.0±17.4,103.5±13.9 (p=0.9), 100.6±14.4 (p=0.11) and 99.8±14.6 (p=0.02) respectively and general linear model analysis confirmed this evolution (figure 1) (p=0.02) mean HbA1c at 0, 90 and365 was 5.4±0.5, 5.5±0.6 and 5.4±0.4 respectively (pNS). None of the patients developed DM (requiring treatment) after conversion. The percentage of IFG was 51, 58, 40 and 49%respectively. Mean doses of prednisone in those patients receiving steroids were 6.6 mg/day at conversion and 6.1 mg/day at 1y. Mean Eve dose at 1y was 3.1 mg/day (1-6) and mean through levels were6.4 ng/mL.

CONCLUSIONS: Conversion to Everolimus with CNI elimination in renal transplant patients is followed by a significant improvement in glucose metabolism. Although it has been atributed a diabetogeniceffect to mTOR inhibitors this effect seems to be less intense than that induced by CNI.

Disclosure: All authors have declared no conflicts of interest.