DOI: 10.4103/ijot.ijot_133_25 ISSN: 2212-0017

Conversion to Everolimus in Renal Transplant Recipients: Real-world Outcomes from a 13-year Single-center Experience

M. Niranjan, Vijay Chander Bukka, Pallavi Uppal, Ankit Tiwari, Ramapriya Rengaswamy, Vishnukeerthana Kotha, Kaushik Sridhara, B Katyayani, M. Prasanna, Siddharth Herur, Gangadhar Taduri, Swarnalatha Guditi
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Background:

Everolimus (EVL), a mammalian target of rapamycin inhibitor, offers a potential strategy for calcineurin inhibitor (CNI) minimization in renal transplant recipients, aiming to reduce nephrotoxicity and metabolic complications while maintaining graft outcomes. Real-world evidence from Indian centers remains limited.

Methodology:

This retrospective, single-center study analyzed adult kidney transplant recipients (2010–2023) converted to EVL for protocol-based pre-emptive switching, biopsy-proven CNI toxicity, or mycophenolate mofetil (MMF) intolerance. Patients with stable graft function, low immunological risk, and minimal proteinuria were included. Clinical data, graft function, infection and rejection rates, and drug toxicities were compared pre- and post-conversion. Subgroup analyses were performed for early (≤6 months) versus late (>6 months) conversion and protocol versus non-protocol indications.

Results:

Ninety-six recipients (mean age 30.6 ± 10.0 years; 81.3% males) were included, predominantly living-related transplants (87.5%). CNI toxicity (41.7%) was the leading reason for conversion. Overall infections decreased postconversion (44.8% to 33.4%, P = 0.104), with notable reductions in urinary tract infections (15.6%–6.3%) and cytomegalovirus disease (11.5%–7.3%). Rejection rates were stable (15.6% vs. 14.6%), though acute T cell-mediated rejection declined and chronic acute antibody-mediated rejection emerged in some cases. Early conversion was associated with higher drug toxicities (35% vs. 8.3%, P = 0.003), while graft function remained comparable across groups. At a mean follow-up of 58.7 months, graft and patient survival were 87.5% and 86.5%, respectively.

Conclusion:

Conversion to EVL is a safe and effective CNI-sparing strategy in selected Indian renal transplant recipients, with stable graft function, reduced specific infections, and acceptable rejection rates. Early conversion may increase drug-related toxicities, underscoring the importance of timing and patient selection.

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