Long-Term Experience With Everolimus in Kidney Transplantation in the United States

Background. Limited long-term data exist on US kidney transplant patients who have received everolimus at time of transplantation. Methods. Using data from the United Network for Organ Sharing/Organ Procurement Transplant Network database, we described patient characteristics and outcomes among adult patients who received a kidney transplant between 1998 and 2007 and received everolimus maintenance immunosuppression (n = 392) at time of discharge. Outcomes included acute rejection, new-onset diabetes posttransplant, primary graft failure, and serum creatinine. We included single-organ, first-time transplants between 1998 and 2007 as a reference group. Results. Primary graft survival at 3 and 5 years posttransplantation was 87.2% +/- 2.1% (95% confidence interval [CI]: 82.5%-90.7%) and 77.4% +/- 3.0% (95% CI: 70.8%-82.7%), respectively, in the everolimus-treated group. Improved graft survival with everolimus seemed to be more pronounced in recipients of deceased donor transplants despite the fact that everolimus-treated patients quantitatively had a higher rate of acute rejection at 3 years posttransplant versus the reference group. Conclusion. Although the incidence of acute rejection was slightly higher in the everolimus-treated patients, graft survival at 3 and 5 years posttransplantation favored everolimus, with the effect being particularly notable in the recipients who received deceased donor renal transplants.