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Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Repeat kidney transplantation poses unique challenges, particularly in sensitized recipients with prior graft failures. Conventional calcineurin inhibit(CNI)- based regimens can exacerbate nephrotoxicity and immunological risk.Everolimus, an mTOR inhibitor, offers a potential alternative by enabling CNI minimisation while maintaining adequate immunosuppression.we report a case of successful de novo everolimus use in a patient undergoing a third renal transplant after two previous graft loses.
A 47 year-old male with end-stage renal disease secondary to chronic glomerulonephritis underwent a third kidney transplant from a deceased donor in April2025. He had prior grafts from a living - related donor (2014) and a deceased donor (2019), both of which failed due to chronic allograft dysfunction and graft thrombosis , respectively .The patient was highly sensitized (PRA>80%) and received an ABOc deceased donor kidney as the donor cross match was negative. Induction therapy with low dose antithymocyte globulin was followed by a de novo regimen of everolimus ( target trough 3-8 ng/ml) with low dose of Tacrolimus and steroids. Mycophenolate mofetil was withdrawn early due to severe gastroenteritis. He had delayed graft function requiring 11 sessions of Hemodialysis in immediate post operative period. Wound dehiscence was observed but resolved with secondary suturing . At six months , the patient demonstrates stable graft function ( serum creatinine 1.8 mg/ dl) with Tacrolimus trough 4.0 ng/dl, everolimus trough3.5ng/dl, no opportunistic infections and no proteinuria.
This case illustrates the feasibility and efficacy of everolimus based immunosuppression in a highly sensitized recipient with multiple prior graft losses . The strategy provided adequate immunologic control while minimising CNI exposure. Everolimus may be especially advantageous in reducing nephrotoxicity , viral infections, proteinuria, malignancy risk in complex , high immunologic risk kidney transplant recipients.
Our findings align with the results of the TRANSFORM trial ( Pascual et al.,Am J Transplant 2019), which demonstrated comparable graft outcomes and lower viral infection rates with everolimus - facilitated CNI minimization . The delayed wound healing observed in our patient also reflects the known MTOR - related adverse effect profile reported in large multicenter studies, reinforcing the consistency between individual clinical observations and randomised trial data . Individualized dosing and vigilant monitoring remain essential for optimizing outcomes .
