title: Severe acute renal failure after exposure to sirolimus-tacrolimus in two living donor kidney recipients.
abstract: BACKGROUND
  We began a clinical trial in African Americans comparing sirolimus-tacrolimus to standard immunosuppression. We report two African American male living donor kidney recipients who developed acute renal failure after exposure to sirolimus-tacrolimus.
  
  
  METHODS
  Both patients received similar doses of sirolimus and tacrolimus to achieve target levels of 5 to 15 ng/mL and prednisone in tapering doses. Renal function and tacrolimus and sirolimus levels were systematically monitored.
  
  
  RESULTS
  Although both kidneys functioned immediately, acute oliguric renal failure developed approximately 2 weeks after transplantation. Transplant kidney biopsy showed acute tubular necrosis in patient 2. Sirolimus-tacrolimus was then stopped in both patients. Both patients required temporary hemodialysis. Renal function returned 2 weeks later and was normal 2 months after transplantation on tacrolimus plus mycophenolate mofetil.
  
  
  CONCLUSIONS
  Combination sirolimus-tacrolimus may cause nephrotoxicity in some patients by mechanisms that are presently unexplained.
authors.affiliation: Nephrology Section, Department of Medicine, Washington Hospital Center, Washington, D.C., USA.
authors.forename: Loredo
authors.initials: L
authors.lastname: Lawsin
authors.forename: Jimmy A
authors.initials: JA
authors.lastname: Light
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000009:adverse effects*; D016559:Tacrolimus / Q000009:adverse effects*; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus