Introduction of everolimus in kidney transplant recipients at a late posttransplant stage

This minireview focuses on the current knowledge about the introduction of everolimus(EVL),a mammalian target of rapamycin inhibitor,with calcineurin inhibitor(CNI)elimination or minimization in kidney transplant recipients at a late posttransplant stage.Within,we have summarized two major clinical trials,ASCERTAIN and APOLLO,and seven other retrospective or nonrandomized studies.In the open-label multicenter ASCERTAIN study,the estimated glomerular filtration rate(eGFR)at 24 mo after conversion was not significantly different between three groups-EVL with CNI elimination,CNI minimization and continued CNI unchanged-at a mean of 5.4 years after transplantation.However,recipients with baseline creatinine clearance higher than 50 mL/min had a greater increase in measured GFR after CNI elimination.In the open-label multicenter APOLLO study,adjusted e GFR within the on-treatment population was significantly higher in the EVL continuation group than in the CNI continuation group at 12 mo after conversion at a mean of 7 years posttransplantation.Other studies on recipients without adverse events and already having satisfactory renal function showed favorable graft function by EVL late-induction with CNI elimination or reduction.These studies showed that chronic allograft nephropathy,CNI nephrotoxicity,CNI arteriolopathy,cancer and viral infection(especially cytomegalovirus infection)may be good indications for late conversion to EVL.