Evidence-based practice: Guidance for using everolimus in combination with low-exposure calcineurin inhibitors as initial immunosuppression in kidney transplant patients

Transplant Rev (Orlando). 2019 Oct;33(4):191-199. doi: 10.1016/j.trre.2019.07.001. Epub 2019 Jul 23.


The mammalian target of rapamycin (mTOR) inhibitor, everolimus, in combination with reduced-exposure calcineurin inhibitor (CNI), has been demonstrated in clinical trials to have comparable efficacy in low-to-moderate immunological risk kidney transplant recipients to the Standard of Care, mycophenolic acid (MPA) in combination with standard-exposure CNI. Current treatment guidelines consider mTOR inhibitors to be a second-line therapy in the majority of cases; however, given that everolimus-based regimens are associated with a reduced rate of viral infections after transplantation, their wider use could have great benefits for kidney transplant patients. In this evidence-based practice guideline, we consider the de novo use of everolimus in kidney transplant recipients. The main outcomes of our consideration of the available evidence are that: 1. Everolimus, in combination with reduced-exposure CNI and low dose steroids, is a suitable regimen for the prophylaxis of kidney transplant rejection in the majority of low-to-moderate immunological risk adult patients, with individualized management; 2. Induction with either basiliximab or rabbit anti-thymocyte globulin is an effective therapy for kidney transplant recipients when initiating an everolimus-based, reduced-exposure CNI regimen; and 3. An individualized approach should be adopted when managing kidney transplant recipients on everolimus-based therapy.

Keywords: Everolimus; Guidelines; Kidney; Transplantation; mTOR inhibitor/mTORi.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Calcineurin Inhibitors / administration & dosage*
  • Drug Therapy, Combination
  • Everolimus / administration & dosage*
  • Evidence-Based Practice
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Humans
  • Immunosuppression Therapy / methods
  • Immunosuppressive Agents / administration & dosage*
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / methods*
  • Male
  • Practice Guidelines as Topic*
  • Precision Medicine / methods
  • Risk Assessment
  • Treatment Outcome


  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Everolimus