ImmunosuppressionComplication: Metabolic disorderStudy of Anemia After Late Introduction of Everolimus in the Immunosuppressive Treatment of Renal Transplant Patients
Section snippets
Materials and Methods
We studied iron homeostasis in 43 patients after late introduction of everolimus in the immunosuppressive treatment. Hemoglobin concentration, red blood cell count, mean corpuscular volume, serum iron, and ferritin levels as well as transferrin saturation were evaluated 3 months before as well as 1, 3, and 6 months after the switch. Anemia was defined as an hemoglobin level < 12 g/dL in men and <11.5 g/dL in women.
The changes in variables with time (pre- and posttreatment) were estimated by
Results
The causes for everolimus switching were cardiovascular disease (n = 16), tumors (n = 11), chronic allograft nephropathy (n = 8), calcineurin inhibitor toxicity (n = 4), and others (n = 4). The median time from transplant was 82 months (range 6 to 160). Forty patients (93%) were previously treated with calcineurin inhibitors (50% cyclosporine and 50% tacrolimus). These drugs were discontinued in all patients after the introduction everolimus [median time for the calcineurin inhibitor
Discussion
With regard to immunosuppression and its potential role in posttransplant anemia, the use of mycophenolate mofetil (MMF), sirolimus, or a combination of MMF and calcineurin inhibitor therapy seemed to be associated with a relatively high prevalence of anemia with a significant difference in hemoglobin values between patients being treated with these agents and those not on treatment. The TRESAM survey2 showed that therapy with MMF or azathioprine was associated with a greater likelihood of
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Anemia and Immunosuppressive Regimen in Renal Transplanted Patients: Single-Center Retrospective Study
2016, Transplantation ProceedingsCitation Excerpt :Other data arise from smaller studies whose aim was to evaluate PTA. The rate of PTA was similar in liver transplanted patients treated with Rad or Cya [12], whereas in a late conversion study [13], the switch from Cya to Rad caused an increase in the percentage of patients affected by PTA from 18% to 34% that returned to 18% 6 months after the conversion. Our study has several limitations, being a retrospective, observational, small monocentric study.
Everolimus-induced hematologic changes in patients with metastatic breast cancer
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2014, Transplantation ReviewsCitation Excerpt :Immunosuppression with mTOR inhibitors can promote anemia and delay improvement in hemoglobin levels after surgery [94]. Anemia associated with mTOR inhibitors is characterized by microcytosis (ie, marked decline in mean corpuscular volume of red blood cells [RBCs]) and low serum iron levels [10,95,96]. It is generally mild, dose-dependent, and reversible upon discontinuation of treatment [10].
Blood disorders after kidney transplantation
2014, Transplantation ReviewsAnemia in kidney transplants without erythropoietic agents: Levels of erythropoietin and iron parameters
2012, Transplantation ProceedingsEverolimus and enteric-coated mycophenolate sodium Ab initio after liver transplantation: Midterm results
2012, Transplantation ProceedingsCitation Excerpt :These results suggested that EVR and EC-MPS ab initio may be used to prevent renal dysfunction especially among patients who showed renal impairment before surgery. As reported by Masetti23 and Sanchez Fructuoso,24 hematologic side effects of the antimetabolite in association of PSI were rare. In our cohort only one patient who developed leukopenia after 9 months completely recovered after EC-MPS withdrawal, suggesting the hematotoxicity was rare and easily managed.