• heart transplantation;
  • children;
  • renal insufficiency;
  • everolimus

Behnke-Hall K, Bauer J, Thul J, Akintuerk H, Reitz K, Bauer A, Schranz D. Renal function in children with heart transplantation after switching to CNI-free immunosuppression with everolimus. Pediatr Transplantation 2011: 15: 784–789. © 2011 John Wiley & Sons A/S.

Abstract:  Renal impairment because of CNI contributes to long-term morbidity. Therefore, CNI avoiding or sparing treatment strategies are important. In this article, we describe the results of a CNI-free treatment protocol with regard to recovery of renal function. Twenty-eight patients with heart transplantation were switched from CNI regimen to everolimus and mycophenolate, when cGFR was <75 mL/min/1.73 m2. In all patients, CNI was stopped, when everolimus trough levels of 5–8 ng/L were achieved. Serum creatinine and cGFR were determined before and after 6 and 12 months. Median serum creatinine decreased from 1.2 mg/dL (range 0.7–3.7) before everolimus to 1.0 (range 0.6–1.8) and 1.0 (range 0.5–1.9) mg/dL after 6 and 12 months. Median cGFR was 47.81 (range 18.3–72.6) mL/min/1.73 m2 before everolimus and 63.1 (range 37.8–108.7) mL/min/1.73 m2 at six months and 64.8 (range 37.7–106.6) mL/min/1.73 m2 after 12 months. All changes from baseline to six and 12 months were statistically significant (p < 0.05). Adverse events were infections (n = 3) and rejections (n = 3). Therapy was discontinued in four patients. Conversion to CNI-free immunosuppression resulted in significant improvements of renal function within six months of CNI withdrawal. Side effects are common. However, more studies are required to demonstrate the effectiveness in children.