Early conversion from cyclosporine to everolimus following living-donor kidney transplantation: outcomes at 5 years posttransplant in the randomized ZEUS trial

Abstract

Early initiation of everolimus with calcineurin-inhibitor (CNI) withdrawal after LDKT improved graft function to 5 years post-transplant compared to standard CNI-based therapy. The renal benefit was concentrated in patients who remained on everolimus. An increase in mild acute rejection was not associated with long-term graft loss.

Switch to an everolimus‐facilitated cyclosporine A sparing immunosuppression improves glycemic control in selected kidney transplant recipients

“…9,14,31,34 Data concerning mTORi use are conflicting. 23,25,35,36 Our study suggests an enhanced insulin resistance in patients on 26,27 Hence, the switch to an EVR-based immunosuppression seems feasible especially in patients with disturbed glucose metabolism on the one hand and a low immunological risk on the other hand.…”

“…However, these results are consistent with previous studies. The ZEUS study revealed a significant improvement in renal function 6 and 12 months after transplantation, which was maintained 5 years after . The CONCEPT and the CONVERT study also showed an improved renal function in SRL‐treated patients compared to CsA therapy .…”

“…However, in some patients the steroid pulses might have accelerated the progression from IFG to clinically manifest diabetes, thereby explaining the similar rate (7%‐8%) of NODAT in both groups at the end of the study period. The assumption of a higher general incidence of BPAR episodes in mTORi‐based regimens might, therefore, explain the increased risk of NODAT observed in several clinical studies …”

“…A software‐based random matching with the remaining 158 patients that were on a continued CsA therapy (control group) was then performed in order to create equal group sizes. Of all 146 patients included, 113 (EVR: n=73, CsA: n=40) were formerly enrolled in two prospective randomized multicenter controlled trials: the HERAKLES study (EUDRA‐CT 2006‐007021‐32, 106 patients included in our center) and the ZEUS study (EUDRA‐CT 2004‐004346‐40, 48 patients included in our center) …”

“…Of all 146 patients included, 113 (EVR: n=73, CsA: n=40) were formerly enrolled in two prospective randomized multicenter controlled trials: the HERAKLES study (EUDRA-CT 2006-007021-32, 106 patients included in our center) and the ZEUS study (EUDRA-CT 2004-004346-40, 48 patients included in our center). [24][25][26][27]…”