Abstract

FARINHA, Ana et al. Inhibitors of the mammalian target of rapamycin in kidney transplantation: impact of conversion on allograft and patient survival. Port J Nephrol Hypert [online]. 2013, vol.27, n.2, pp.101-107. ISSN 0872-0169.

Background: Inhibitors of the mammalian target of rapamycin (mTOR) have demonstrated a similar outcome on allograft loss but its impact on patient survival has only recently been evaluated. In this outcome analysis all renal transplants performed at our unit since 1/1/2006 until 12/31/2011, were evaluated. Allograft failure and mortality were compared between patients who were converted to mTOR and those who remained on a calcineurin inhibitor (CNI). Population and Methods: We have evaluated 425 patients (mean age 46±13 years, 60.7% male, 10.1% diabetics, mean follow-up of 44 months). During this period, 123 patients were converted to mTOR: 8 included in a protocol study, 13 due to malignancy and 102 to evidence of chronic pallograft dysfunction. The remaining patients were maintained on a CNI -based regimen. We compared patient and graft survival by Kaplan-Meier analysis and p < 0.05 was considered significant. Results: During the follow-up time, 10 patients died and 28 lost their graft. Baseline characteristics were similar, except for age(converted patients were older, p = 0.012), gender (higher male percentage in mTOR group, p = 0.04) and race (Caucasians were more prevalent in mTOR arm, p = 0.012). There was no difference between the 2 groups on either graft or patient survival, even after adjustment for age, gender, and presence of diabetes mellitus or immunological risk. Moreover, in the subgroup of patients with low immunological risk, the use of mTOR was associated with a trend towards improved renal allograft survival, although not statistically significant (p = 0.06). Conclusion: Despite worse prognosis conferred by the major indications for conversion to mTOR inhibitors (malignancy or chronic allograft dysfunction) and older age, we found no difference on allograft or patient survival between the 2 groups (mTOR versus CNI -based regimen). In patients with low immunological risk, mTOR group showed a trend towards better allograft survival.

Keywords : Allograft failure; calcineurin inhibitor; inhibitors of the mammalian target of rapamycin; mortality.

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