Retrospective evaluation of drug side effects in renal transplant patientsreceiving mtor inhibitors

Renal transplantation is the ideal treatment modality for end stage renal disease. Immunosuppressive therapy is practically applied to all kidney allograft recipients except for identical twins. Because of its positive effects on graft functions in renal transplant patients in the long term, recently mTORi usage increased in renal transplant recipients. Although mTORi have a positive effect on renal function, a significant number of patients had to discontinue the drug due to side effects. In this retrospective study, we aimed to evaluate the efficacy and side effects of mTORi in renal transplant patients. Data of 154 renal transplant recipients who were followed in the Nephrology Department of Hacettepe University Faculty of Medicine and who hd usedany type of mTOR inhibitor at any period of their follow-up were evaluated. Creatinine at the time of initiation of mTOR inhibitor was 1.53 [0.61-4.04] mg/dL, GFR was 50 [15-135] ml /min, proteinuria was168 [19-4100] mg/day. Creatinine was 1,35. [0.70-4.73] mg/dL, GFR was 63 [10-110] ml/min, proteinuria was 297 [76-1146] mg/day. Creatinine was significantly lower (p = 0.012); GFR (p = 0.004) and proteinuria (p <0.001) were significantly higher at month 60. Twenty-nine (53.7%) patients in the sirolimus group and 32 (32.0%) patients in the everolimus group disontinued treatment (p = 0.009). A total of 46 (29.9%) patients had proteinuria, 62 (40.3%) patients had bone marrow suppression and 32 (20.8%) patients had hyperlipidemia. There were no significant differences in proteinuria (p = 0.07), bone marrow suppression (p = 0.142), hyperlipidemia (p = 0.07) and rejection (p = 0.11). Proteinuria was the most common cause of mTORi discontinuation with a rate of 42.6%. It was found that 76.6% of the patients grefts were still functional at the end of follow-up period. In the Everolimus group, the number of patients living with functional kidney was higher than the sirolimus (86% vs. 59.3%, respectively; p <0.001). Key words: Adverse effects, efficacy, kidney transplantation, mTOR inhibitors