title: Addition of sirolimus to cyclosporine delays the recovery from delayed graft function but does not affect 1-year graft function.
abstract: Delayed graft function (DGF) has long been identified as one of the main correlates of poor graft survival in cadaveric renal transplantation, but the factors that affect its onset and duration are not fully elucidated. The impact of two immunosuppressive protocols on the incidence and length of DGF among kidney transplant recipients of a suboptimal organ was evaluated. Patients were randomly treated with corticosteroids (CS); low-dose cyclosporine (CsA) and sirolimus (SRL; group 1; n = 42); or CS, full-dose CsA, and mycophenolate mofetil (group 2; n = 48). All recipients received immunoprophylaxis with basiliximab. After 3 mo, group 1 discontinued CsA and continued with SRL, whereas group 2 continued the same treatment. The incidence of DGF was similar in the two groups (group 1 = 52.4%; group 2 = 58.3%), whereas its duration was significantly higher in the group 1 (19.0 +/- 6.0 versus 10.3 +/- 3.2 d; P = 0.001). Both groups showed 100% actuarial graft and patient survival at 1-yr. Among DGF patients, serum creatinine (sCr) at discharge was significantly worse in group 1 (sCr, 3.0 +/- 1.0 versus 1.5 +/- 0.2 mg/dl; calculated creatinine clearance, 31.2 +/- 9.3 versus 61.1 +/- 10 ml/min; P = 0.001). During the first year, the former group displayed a significant improvement of graft function, such that at 1-yr, no difference could be measured between groups (sCr, 1.8 +/- 0.5 versus 1.7 +/- 0.4 mg/dl; calculated creatinine clearance, 51.5 +/- 10.2 versus 53.3 +/- 9.4 ml/min). In conclusion, in de novo renal transplanted patients, the administration of SRL, in combination with low-dose CsA, is associated with a delayed recovery from DGF but does not worsen 1-yr graft function.
authors.affiliation: Department of Emergency and Organ Transplantation, Division of Nephrology, University of Bari, Policlinico, Bari, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stallone
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Paolo
authors.forename: Antonio
authors.initials: A
authors.lastname: Schena
authors.forename: Barbara
authors.initials: B
authors.lastname: Infante
authors.forename: Michele
authors.initials: M
authors.lastname: Battaglia
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ditonno
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grandaliano
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Schena
mesh_terms: D016572:Cyclosporine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000502:physiology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy; D020127:Recovery of Function; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus