Reversal of loss of glomerular filtration rate in children with transplant nephropathy after switch to everolimus and low-dose cyclosporine A

Pediatr Transplant. 2007 May;11(3):291-5. doi: 10.1111/j.1399-3046.2006.00651.x.


Until now there have been no good therapeutic options in children with biopsy-proven transplant nephropathy (TN) and loss of glomerular filtration rate (GFR) while receiving cyclosporine A (CsA), mycophenolate mofetil (MMF) and prednisolone (Pred). In 13 kidney transplanted children (mean age 13 yr, SD 4) with CsA/MMF/Pred immunosuppression, renal biopsy revealed significant TN. MMF was discontinued, CsA dose was reduced to 50% and Everolimus was started (1.6 mg/m(2)/day). Pred was stopped in 10 of 13 patients. The mean GFR was 55 mL/min/1.73 m(2) (SD 24) one yr before switch, 45 mL/min/1.73 m(2) (SD 16, p < 0.05) at the time of switch and 47 mL/min/1.73 m(2) (SD 18, p < 0.05) 12 months later. There were no severe side-effects or acute rejections. Lactate dehydrogenase, cholesterol, creatine kinase, and U-albumin/creatinine ratio did not increase significantly. After six months, the mean certican-C0 level was 4.0 microg/L (SD 1.5) and mean CsA-C0 level was 52 ng/mL (SD 23). The GFR of transplanted kidneys in children with TN improved by changing immunosuppression from CsA/MMF/Pred to everolimus and low-dose CsA.

MeSH terms

  • Adolescent
  • Biopsy
  • Child
  • Cyclosporine / therapeutic use*
  • Drug Therapy, Combination
  • Everolimus
  • Female
  • Glomerular Filtration Rate* / drug effects
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Diseases / drug therapy*
  • Kidney Diseases / etiology*
  • Kidney Diseases / pathology
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / pathology
  • Male
  • Sirolimus / analogs & derivatives*
  • Sirolimus / therapeutic use


  • Immunosuppressive Agents
  • Cyclosporine
  • Everolimus
  • Sirolimus