Early Switch To Mammalian Target Of Rapamycin Inhibitors Is A Sustainable Treatment Approach In Renal Transplant Recipients: 7 Year Results

Objective The aim of this study was to investigate the safety and sustainability of mammalian target of rapamycin inhibitor (m-TORi) based treatment protocols in renal transplant patients. Methods We retrospectively evaluated a total of 206 patients who were switched to low-dose calcineurin inhibitors (CNI)+m-TORi or mycophenolate mofetil (MMF)+m-TORi treatment protocols in the first 3 months of renal transplantation between January 2010 and August 2011 in our center. Demographic and laboratory features of the patients were recorded. Results Of the patients included in the study, 89 (43.2%) were female and 117 (56.8%) were male. Mean age was 41.9±13.8 years. Panel reactive antibody (PRA) was negative in 95% of the recipients. 134 (65%) patients received anti-thymocyte globulin (ATG) induction therapy. Initially, 108 patients were treated with cyclosporine and 98 (47.6%) were treated with tacrolimus based regimens. 135 patients (65.5%) were switched to low-dose CNI+m-TORi and 71 patients (34.5%) were switched to MMF+m-TORi. Mean switching time was 3 months. At the end of the study, 161 patients (78.2%) were still continuing the m-TORi treatment protocol and 45 patients (21.8%) could not continue for various reasons (11.4% proteinuria, 5.5% edema, 2.9% acute rejection, 1% acne+oral aphthae, 1% neuropathy). Biopsy-proven acute rejection rate was 4.5% (n=9). Mean duration of sustainability of m-TORi treatment protocol was 84.15±6.79 months. Mean serum creatinine of patients who were still continuing m-TORi was 1.42±1.09 mg/dl. Conclusion Switching to m-TORi in the early posttransplant period is a safe and sustainable treatment approach.