Effect of Everolimus with Low-Dose Tacrolimus on Development of New-Onset Diabetes After Transplantation and Allograft Function in Kidney Transplantation: A Multicenter, Open-Label, Randomized Trial
Hyung Duk Kim, Ji-Yeun Chang, Byung Ha Chung, Chan-Duck Kim, Sang-Ho Lee, Yeong Hoon Kim, Chul Woo Yang
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
Ann Transplant 2021; 26:e927984
Available online: 2020-11-30
This randomized controlled trial aimed to investigate the effect of everolimus (EVL) with low-dose tacrolimus (Tac) on the development of post-transplantation diabetes mellitus (PTDM) in kidney transplantation (KT).
MATERIAL AND METHODS: Seventy-seven kidney transplant patients from 4 transplant centers were included. Patients were randomized to the “EVL group” (n=38) and the “TAC group” (n=39). The target Tac trough level was 2 to 5 ng/mL in the EVL group and 5 to 10 ng/mL in the TAC group.
RESULTS: The 1-year cumulative incidence of PTDM in all patients was 7.8%, and no difference was found between the 2 groups (P=0.0819). Insulin resistance measured with the homeostatic model assessment for insulin resistance showed a significant increase only in the TAC group (1.11 to 1.30, P=0.0492). Allograft rejection rate and estimated glomerular filtration rate (eGFR) follow-ups every 3 months were not significantly different between the 2 groups. However, the EVL group showed a significant increase in the mean eGFR at 9 months and 12 months after KT compared to the baseline value (P=0.0242 and 0.0491, respectively).
The EVL group showed lower insulin resistance and higher allograft function in comparison to the TAC group.
CONCLUSIONS: EVL-based immunosuppressive therapy with lower Tac exposure could be a safer alternative for maintenance treatment.
Keywords: Diabetes Mellitus, Graft Rejection, Kidney Transplantation