Escola Paulista de Medicina
Postgraduate in Clinical Endocrinology

Late Conversion to Sirolimus or Everolimus After Pancreas Transplant (2020)

Rubens Marcella-Neto a, João R. de Sá b, Cláudio S. Melaragno a, Adriano M. Gonzalez c,
Alcides Salzedas-Neto c, Marcelo M. Linhares c, José O. Medina-Pestana a, and Érika B. Rangel a,
a Nephrology Division, Federal University of São Paulo/Hospital do Rim e Hipertensão, São Paulo, SP, Brazil;

b Endocrinology Division, Federal University of São Paulo, São Paulo, SP, Brazil;

c Surgery Department, Federal University of São Paulo, São Paulo, SP, Brazil

ABSTRACT
Background. Pancreas transplant is an effective treatment for insulin-dependent diabetic
individuals with end-stage renal disease, yet immunosuppression-associated adverse events
may adversely affect patient and graft survival. The aim of the study was to document
whether mammalian target of rapamycin inhibitors (mTORi) are safe and effective as a
second-line drug after pancreas transplant.
Methodology. An observational single-center study was performed in a cohort of 490
simultaneous pancreasekidney transplant and 45 pancreas-after-kidney transplant
individuals after conversion to mTORi (n ¼ 13) owing to adverse events of either
tacrolimus or mycophenolate.
Results. mTORi conversion was performed 11.5  10.1 (range, 1-28) months after
pancreas transplant, mainly owing to cytomegalovirus infection and gastrointestinal intolerance.
We frequently observed clinical complications after mTORi conversion, yet
creatinine, eGFR, proteinuria, fasting plasma glucose, HbA1c, and C-peptide remained
stable throughout the study (mean follow-up 8.2  5, range 1-17) years, as did the lipid
profile (P > .05). However, graft loss occurred in almost 20% of patients owing to
chronic alterations.
Limitations. The small number of patients and a single-center cohort were limitations of
the study.
Conclusions. Late mTORi conversion is a safe and effective approach when tacrolimus
or mycophenolate-mediated adverse events occur after pancreas transplant.
 

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