Renal Transplantation in the Elderly

• Pharmacokinetic of Tacrolimus [ Time Frame: Days: 7, 30, 60, 67, 90, 180. ] [ Designated as safety issue: Yes ]
  Pharmacokinetic of Tacrolimus in the study population at days 7, 30, 60, 67, 90 and 180 post-transplant.
• Serious adverse events [ Time Frame: Every year, for five years ] [ Designated as safety issue: Yes ]
  Evaluate serious adverse events (as internationally defined by ICH-GCP).
• Biopsy [ Time Frame: Every year, for five years ] [ Designated as safety issue: Yes ]
  Biopsy proven acute rejection rated every year, for five years.
• Renal filtration markers [ Time Frame: Days: 7, 30, 37, 60, 67, 90, 180. Months: 12, 18, 24, 36, 48, 60 ] [ Designated as safety issue: No ]
  Identify which of the renal filtration markers existing today, Cystatin C or Serum Creatinine, is more adequate to monitor renal function in elderly transplant and to develop abbreviated equations for eGFR from day 7 on.
• Bone density [ Time Frame: Month 12 ] [ Designated as safety issue: No ]
  Evaluation of bone density at month 12 post-transplant.
• Vitamin D [ Time Frame: Months: 2, 12. ] [ Designated as safety issue: No ]
  Evaluation of vitamin D at months 2 and 12 post-transplant.
• Gonadal function [ Time Frame: Months: 1, 12. ] [ Designated as safety issue: No ]
  Evaluation of gonadal function at months 1 and 12 post-transplant.
• Quality of Life [ Time Frame: Months: 1, 12, 18, 24, 36, 48, 60. ] [ Designated as safety issue: No ]
  Evaluate Quality of Life at months 1, 12, 18, 24, 36, 48 and 60 post-transplant in the study population.
• Left Ventricular Mass (LVM) [ Time Frame: Month: 12. ] [ Designated as safety issue: Yes ]
  Left Ventricular Mass (LVM) measured by echocardiography at the end of the first year.
• Left Ventricle Ejection Fraction (LVEF) [ Time Frame: Month: 12. ] [ Designated as safety issue: Yes ]
  Left Ventricle Ejection Fraction (LVEF) measured by echocardiography at the end of the first year.
• Pharmacokinetic of Everolimus [ Time Frame: Days: 7, 30, 60, 67, 90, 180. ] [ Designated as safety issue: Yes ]
  Pharmacokinetic of Everolimus in the study population at days 7, 30, 60, 67, 90 and 180 post-transplant.
• Pharmacokinetic of Mycophenolate Sodium [ Time Frame: Days: 7, 30, 60, 67, 90, 180. ] [ Designated as safety issue: Yes ]
  Pharmacokinetic of Mycophenolate Sodium in the study population at days 7, 30, 60, 67, 90 and 180 post-transplant.

• Pharmacokinetic study of immunosuppressive drugs [ Time Frame: Days: 7, 30, 60, 67, 90, 180. ] [ Designated as safety issue: Yes ]
  Tacrolimus, Everolimus and Mycophenolate Sodium in the study population at days 7, 30, 60, 67, 90 and 180 post-transplant.
• Serious adverse events [ Time Frame: Every year, for five years ] [ Designated as safety issue: Yes ]
  Evaluate serious adverse events (as internationally defined by ICH-GCP).
• Biopsy [ Time Frame: Every year, for five years ] [ Designated as safety issue: Yes ]
  Biopsy proven acute rejection rated every year, for five years.
• Renal filtration markers [ Time Frame: Days: 7, 30, 37, 60, 67, 90, 180. Months: 12, 18, 24, 36, 48, 60 ] [ Designated as safety issue: No ]
  Identify which of the renal filtration markers existing today, Cystatin C or Serum Creatinine, is more adequate to monitor renal function in elderly transplant and to develop abbreviated equations for eGFR from day 7 on.
• Bone density [ Time Frame: Month 12 ] [ Designated as safety issue: No ]
  Evaluation of bone density at month 12 post-transplant.
• Vitamin D [ Time Frame: Months: 2, 12. ] [ Designated as safety issue: No ]
  Evaluation of vitamin D at months 2 and 12 post-transplant.
• Gonadal function [ Time Frame: Months: 1, 12. ] [ Designated as safety issue: No ]
  Evaluation of gonadal function at months 1 and 12 post-transplant.
• Quality of Life [ Time Frame: Months: 1, 12, 18, 24, 36, 48, 60. ] [ Designated as safety issue: No ]
  Evaluate Quality of Life at months 1, 12, 18, 24, 36, 48 and 60 post-transplant in the study population.
• Left Ventricular Mass (LVM) [ Time Frame: Month: 12. ] [ Designated as safety issue: Yes ]
  Left Ventricular Mass (LVM) measured by echocardiography at the end of the first year.
• Left Ventricle Ejection Fraction (LVEF) [ Time Frame: Month: 12. ] [ Designated as safety issue: Yes ]
  Left Ventricle Ejection Fraction (LVEF) measured by echocardiography at the end of the first year.

An exploratory study of the efficacy and safety of a regimen consisted of Everolimus plus low tacrolimus for the immunosuppression in renal transplantation in the elderly.

To evaluate the pharmacokinetics of immunosuppressants that have been little studied in this population.

To evaluate whether the polymorphism of the genes that determine the expression of metabolizing enzymes and transporters of xenobiotics interfere in the elderly, also in the younger population, absorption and metabolism of immunosuppressants.

To evaluate the potential minimization of immunosuppression in this population refers to how does the re-population of peripheral lymphocytes, in this age group, after the use of lymphocyte-depleting agents such as thymoglobulin and subsequently maintained with two regimes.

Clarify which markers of renal filtration exist today, cystatin C and serum creatinine, is the right to monitor renal function in elderly transplanted.

Objectives: The objective of this study is to evaluate the safety and efficacy of everolimus (EVL) combined with low dose of Tacrolimus in comparison with Mycophenolate Sodium (MPS) combined with standard dose of Tacrolimus as immunosuppressive therapy for elderly recipients of kidney transplantation.

Comparison between the two study arms of:

Primary Objective:

1. Composite efficacy failure demonstrated by graft loss and/or death with functional graft and/or GFR (Glomerular Filtration Rate determined by EDTA-Cr51) < 50 ml/min at the end of first year after transplantation and every year until the fifth year.

Secondary Objectives:

1. Pharmacokinetic study of immunosuppressive drugs (Tacrolimus, Everolimus and Mycophenolate Sodium) in the study population at days 7, 30, 60, 67, 90 and 180 post-transplant.
2. Serious adverse events (as internationally defined by ICH-GCP) every year, for five years.
3. Biopsy proven acute rejection rated every year, for five years.
4. Identify which of the renal filtration markers existing today, Cystatin C or Serum Creatinine, is more adequate to monitor renal function in elderly transplant and to develop abbreviated equations for eGFR from day 7 on.
5. Evaluation of other metabolic effects (bone density at month 12 post-transplant; vitamin D at months 2 and 12 post-transplant; and gonadal function at months 1 and 12 post-transplant) and Quality of Life at months 1, 12, 18, 24, 36, 48 and 60 post-transplant in the study population.
6. Left Ventricular Mass (LVM) and Left Ventricle Ejection Fraction (LVEF) measured by echocardiography at the end of the first year.

• Chronic Renal Failure (CRF)
• Graft Failure
• Transplant; Failure, Kidney
• Renal Transplant Rejection

Inclusion Criteria:

• All renal (only) male and female recipients aged ≥ 60, years undergoing kidney transplantation from a living or deceased donor, including Expanded Criteria Donors (ECD).
• Panel Reactive Antibody (PRA) < 30%.
• Patients who consented to participate in the study by signing the informed consent form before the transplant surgery to the 1st post-operative day).

Exclusion Criteria:

• Allergy to any of proposed medications
• Patients with any active infection including HBV, HCV and HIV.