Switch to an everolimus-facilitated cyclosporine A sparing immunosuppression improves glycemic control in selected kidney transplant recipients

Clin Transplant. 2017 Aug;31(8). doi: 10.1111/ctr.13024. Epub 2017 Jul 7.


Background: Mammalian target of rapamycin inhibitors (mToRi) allow calcineurin inhibitor (CNI) sparing therapy in renal transplant recipients with possible beneficial effects on the long-term allograft function and cardiovascular risk. The influence of mToRi on glucose metabolism is still under discussion.

Methods: In a retrospective analysis, renal allograft recipients switched from a cyclosporine A (CsA) to an everolimus (EVR)-based immunosuppression in the first year after transplantation were compared with patients on continued CsA treatment. At 6-month intervals, the prevalence of impaired fasting glucose (IFG) and new onset of diabetes after transplantation (NODAT) were assessed.

Results: A total of 146 renal transplant recipients were included. The cumulative prevalence of IFG and NODAT 30-months post-transplantation was significantly lower in patients switched to an immunosuppression with EVR compared to patients on continued CsA treatment (10% vs 22%, P=.049). However, patients switched to EVR showed a higher incidence of acute cellular rejections in the first 12 months (23% vs 11%, P=.048).

Conclusion: EVR-based immunosuppression was associated with a similar or even improved glycemic control and improved renal function. However, due to higher rejection rates, patients switched to EVR should be carefully selected as rejection therapy with steroids counteracts the benefit in glycemic control.

Keywords: calcineurin inhibitor; cyclosporine A; everolimus; immunosuppression; new-onset diabetes after transplantation; renal transplantation.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Cyclosporine / adverse effects*
  • Cyclosporine / therapeutic use
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Everolimus / therapeutic use*
  • Female
  • Follow-Up Studies
  • Graft Rejection / prevention & control
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications / blood
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Prediabetic State / blood
  • Prediabetic State / diagnosis
  • Prediabetic State / etiology
  • Prediabetic State / prevention & control*
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult


  • Biomarkers
  • Blood Glucose
  • Immunosuppressive Agents
  • Cyclosporine
  • Everolimus