title: Improved freedom from rejection after a loading dose of sirolimus.
abstract: BACKGROUND
  Sirolimus (SIR) in combination with cyclosporine reduces the incidence of acute rejection in renal transplant recipients. Limited data are available regarding SIR in combination with tacrolimus (TAC).
  
  
  METHODS
  A single-center, retrospective review of renal transplant recipients receiving SIR, TAC, and corticosteroids postoperatively was conducted. A total of 118 consecutive renal transplant recipients were included on the basis of availability of day 1 SIR dose information. Seventy-seven patients received an SIR loading dose (SIR-LD) immediately posttransplantation, and 41 patients did not (SIR no loading dose [SIR-NLD]).
  
  
  RESULTS
  The two groups showed similar demographic and transplant characteristics. SIR doses and trough levels were significantly higher in the SIR-LD patients at 1 and 7 days posttransplantation; however, no differences occurred beyond day 7. Patients receiving an SIR-LD experienced significantly better freedom from rejection at 1, 3, and 6 months posttransplantation (P<0.05). This rejection benefit in the SIR-LD group was independent of donor source and use of antibody induction. SIR-LD patients experienced fewer serious infections (12% SIR-LD vs. 27% SIR-NLD, P=0.04) and a lower incidence of delayed graft function (21% SIR-LD vs. 39% SIR-NLD, P<0.05). No significant differences in serum creatinine, hemoglobin, and platelet counts occurred in the first 180 days posttransplantation, but the patients in the SIR-NLD group experienced lower hemoglobin levels at day 30 than those in the SIR-LD group (10.8 g/dL SIR-LD vs. 9.7 g/dL SIR-NLD, P=0.03).
  
  
  CONCLUSIONS
  SIR-LD significantly improves early posttransplantation freedom from rejection in renal transplant recipients without increasing other complications.
authors.affiliation: Westchester Medical Center, Department of Surgery,Valhalla, NY, USA.
authors.forename: Rafik
authors.initials: R
authors.lastname: El-Sabrout
authors.forename: Veronica
authors.initials: V
authors.lastname: Delaney
authors.forename: Fauzia
authors.initials: F
authors.lastname: Butt
authors.forename: Mohamad
authors.initials: M
authors.lastname: Qadir
authors.forename: Pat
authors.initials: P
authors.lastname: Hanson
authors.forename: Sony
authors.initials: S
authors.lastname: Tuteja
authors.forename: David A
authors.initials: DA
authors.lastname: McCollum
authors.forename: Khalid
authors.initials: K
authors.lastname: Butt
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus