Pahari DK, Pahari H. Efficacy and safety of low-dose everolimus and tacrolimus in kidney transplant recipients: A retrospective study. World J Transplant 2026; 16(2): 118249 [DOI: 10.5500/wjt.v16.i2.118249]
Corresponding Author of This Article
Hirak Pahari, MD, Department of Liver Transplant and Hepatobiliary Surgery, Medica Superspeciality Hospital, Mukundapur, Kolkata 700099, West Bengal, India. hirak.pahari@gmail.com
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Transplantation
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Pahari DK, Pahari H. Efficacy and safety of low-dose everolimus and tacrolimus in kidney transplant recipients: A retrospective study. World J Transplant 2026; 16(2): 118249 [DOI: 10.5500/wjt.v16.i2.118249]
World J Transplant. Jun 18, 2026; 16(2): 118249 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.118249
Efficacy and safety of low-dose everolimus and tacrolimus in kidney transplant recipients: A retrospective study
Dilip Kumar Pahari, Hirak Pahari
Dilip Kumar Pahari, Department of Nephrology, Medica Superspeciality Hospital, Kolkata 700099, West Bengal, India
Hirak Pahari, Department of Liver Transplant and Hepatobiliary Surgery, Medica Superspeciality Hospital, Kolkata 700099, West Bengal, India
Co-first authors: Dilip Kumar Pahari and Hirak Pahari.
Author contributions: Pahari DK contributed to the concept design, methodology, data collection and writing of the paper; Pahari H contributed to data collection, analysis and writing and submission of the paper.
Institutional review board statement: Exemption from formal IRB review has been approved, as this is a survey of different treatment teams with no direct patient contact and no identifiable patient information.
Informed consent statement: Since the data is also retrospective and the study is observational in nature, informed consent can be waived in this respect.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Data sharing statement: The data of this study is available on request from the corresponding author or first author.
Corresponding author: Hirak Pahari, MD, Department of Liver Transplant and Hepatobiliary Surgery, Medica Superspeciality Hospital, Mukundapur, Kolkata 700099, West Bengal, India. hirak.pahari@gmail.com
Received: December 28, 2025 Revised: March 15, 2026 Accepted: April 1, 2026 Published online: June 18, 2026 Processing time: 152 Days and 15.7 Hours
Abstract
BACKGROUND
Standard immunosuppressive regimens result in low rejection rates in the first year after transplantation. However, long-term survival rates after renal transplantation remain relatively poor and are associated with drug-induced side effects.
AIM
To assess the effects of switching from traditional mycophenolate mofetil (MMF) combined with steroids and tacrolimus to a low-dose regimen of everolimus and tacrolimus in post-kidney transplant patients, with the aim of reducing the adverse effects of MMF and high-dose calcineurin inhibitors.
METHODS
This was a retrospective, single-center study of patients who received a combination therapy of steroids + tacrolimus (low dose) + everolimus (low dose) after kidney transplantation (KT). Data was obtained from patients who underwent KT between 2007 and 2019. Everolimus was initiated at 0.25 mg twice daily, aiming for pre-dose concentrations of 5-7 ng/mL (combined trough levels of tacrolimus and everolimus). Improvement in graft survival was assessed by measuring serum creatinine, urinary protein, and lipid profiles. Safety studies were conducted to observe drug-induced side effects.
RESULTS
We included 36 patients from a single center. After switching to everolimus, there was a significant reduction in serum creatinine levels which remained stable over one year. Cholesterol levels also improved and remained stable in most patients. Half of the patients reported improvement in their cholesterol levels and continuous stability. Vomiting (47.1%) and diarrhea (32.4%) were the most common adverse effects of MMF treatment. Other side effects included urinary tract infections (20.6%) and anemia (5.9%).
CONCLUSION
Combination therapy with everolimus (low dose) + tacrolimus (low dose) was superior to MMF + tacrolimus in terms of a lower incidence of side effects and stable serum creatinine levels over long-term follow-up.
Core Tip: The use of combination of low dose tacrolimus and everolimus is not common in kidney transplant recipients. We show in our study that the combination therapy with everolimus (low dose) + tacrolimus (Tac) (low dose) as compared to mycophenolate mofetil + Tac is found to be superior in terms of lower incidence of side effects and stable serum creatinine levels over long-term follow-up.
