Evolution of donor-specific antibodies (DSA) and incidence of de novo DSA in solid organ transplant recipients after switch to everolimus alone or associated with low dose of calcineurin inhibitors

Abstract

Background: Everolimus (EVR) is used in organ transplantation to minimize calcineurin inhibitors (CNI). Some studies pointed out an increase in rejection and de novo donor-specific antibodies (DSA) incidence in kidney transplant patients after switch to EVR and CNI withdrawal. The aims of our study were to determine the evolution of anti-HLA antibodies and the incidence of de novo DSA in transplant recipients after conversion to EVR.

Methods: Heart, lung, kidney, and liver transplant recipients were included in a retrospective, monocentric case-control study. Anti-HLA antibodies were identified at transplantation, pre-switch, and at three, six, and 12 months post-switch.

Results: Conversion to EVR was performed about six yr after the transplant, and low-dose CNI was maintained in 60% of patients. We found no statistical difference for rejection, evolution of preformed anti-HLA antibodies or de novo DSA, after conversion to EVR or not. Incidence of anti-class II DSA tended to increase at month 12 whatever the immunosuppressive regimen.

Conclusions: Late conversion to EVR appears to be safe and to not modify the natural evolution of anti-HLA antibodies in organ transplantation. As 60% of patients received EVR and low doses of CNI, it seems that such combinations could be used with a good outcome.

Keywords: donor-specific anti-HLA antibodies; everolimus; mTOR inhibitor; minimization of calcineurin inhibitors.