Retrospective evaluation of everolimus experience in renal transplantation patients at department of pediatric nephrology outpatients

Renal transplantation, one of the kidney replacement therapies, is the most important treatment option for end-stage renal disease. Optimal maintenance immunsuppressive therapy has not been established in pediatric kidney transplantation. The use of calcineurin inhibitors in children improved graft survival in the first year but did not provide a significant improvement in long-term graft loss. Mammalian target of rapamycin inhibitors (mTORi) (sirolimus and everolimus) have been used in immunosuppressive regimens due to their behavior similar to calcineurin inhibitors and less nephrotoxic profiles. The aim of our study was to share our experience of everolimus use in pediatric renal transplant patients. This study included 28 patients who were scanned everolimus of 73 patients who was followed between 2006 January- 2018 March, had renal transplanted before age of 18 by Uludag University Faculty of Medicine, Department of Pediatric Nephrology outpatients. These cases were retrospectively screened until everolimus for the duration of the treatment or until the age of 21 years or until transplated kidney was rejected; the treatment period of the patients was followed up with six-month periods up to 42 months, especially at the month of conversation, 3rd month, 6th month. Of 28 cases, 7 (25%) were female and 21 (75%) were male. 14 patients (50%) received kidney transplant from deceased donor and 14 patients (50%) received kidney transplant from live donor. One case of 28 patients underwent everolimus (everolimus / mycophenolate mofetil / prednisolone) instead of calcineurin inhibitor after renal transplantation. The other cases had everolimus pre-treatment regimens in 16 cases (59,3%) cyclosporine A / mycophenolate mofetil / prednisolone, 9 cases (33,3%) cyclosporine A / mycophenolate mofetil / prednisolone, 1 case (3,7%) cyclosporine A / azathioprine / prednisolone, 1 case (3,7%) tacrolimus / azathioprine / prednisolone. The median time to transition to everolimus treatment after kidney transplantation was 5,88 months (lowest 0,36 months, highest 62,28 months). Three cases of chronic rejection were accepted in 28 cases. 2 patients underwent hemodialysis and 1 patient underwent peritoneal dialysis. The graft survival rate was 96% for 1 year and 86% for 5 years using Kaplan-Meier method. After the transition to everolimus treatment, mean and median whole urea values decreased significantly in the follow-up months. While mean and median all creatinine values decreased numerically, the decrease in 12, 24 and 36 months was not statistically significant. No significant difference was found in HDL, triglyceride values, leukocyte counts. Hemoglobin levels did not appear to decrease, but significantly increased in all follow-up months. There were a total of 70 hospitalizations until 42 months. The reason of hospitalizations were; 43 (61,42%) for infections, 17 (24,28%) for urea and creatinine levels, 4 (5,71%) for hypertension and 2 (2,85%) for serious aphthous stomatitis, 2 (2,85%) for electrolyte abnormalities and 2 (2.85%) for lymphocytes. As a result, everolimus transformation has become an important option in pediatric renal transplant recipients as safety and efficacy. In our study, conversion to everolimus resulted in significant improvement in renal function in accordance with previous studies. To confirm these results in children, it is necessary to follow long-term and more cases numbered to observe side effects.