title: Sirolimus in kidney transplantation from marginal donors.
abstract: Nephrotoxicity caused by calcineurin inhibitors can lead to either delayed graft function or long-term decline of renal function after kidney transplantation. Therefore, recipients of renal transplants from marginal donors require non-nephrotoxic immunosuppression. Eighteen patients received kidney transplants from marginal donors, with a calcineurin inhibitor-free immunosuppressive regimen, based on basiliximab, mycophenolate mofetil, steroids, and sirolimus. Renal graft biopsy was performed in all cases before surgery. Mean follow-up was 11.8 months. We report immediate renal function in 9 patients, delayed graft function in 5 and acute tubular necrosis in 4 patients. One patient was successfully treated for biopsy-proven acute rejection. Hypercholesterolemia and hypertriglyceridemia were the most common adverse effects (n = 13) associated with arthralgia (n = 2) and thrombocytopenia (n = 2). Five patients underwent a switch to tacrolimus, due to sirolimus-induced side effects. Immunosuppression without the use of calcineurin inhibitors is a safe and effective regimen in kidney transplantation, although sirolimus-related side effects still represent a morbidity factor in these patients.
authors.affiliation: Clinica Chirurgica, Università di Roma Tor Vergata, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pisani
authors.forename: O
authors.initials: O
authors.lastname: Buonomo
authors.forename: G
authors.initials: G
authors.lastname: Iaria
authors.forename: B
authors.initials: B
authors.lastname: Iorio
authors.forename: A
authors.initials: A
authors.lastname: Rizzello
authors.forename: S
authors.initials: S
authors.lastname: Pollicita
authors.forename: L
authors.initials: L
authors.lastname: De Luca
authors.forename: M
authors.initials: M
authors.lastname: Valeri
authors.forename: V
authors.initials: V
authors.lastname: Boffo
authors.forename: A
authors.initials: A
authors.lastname: Famulari
authors.forename: C U
authors.initials: CU
authors.lastname: Casciani
mesh_terms: D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000276:immunology* / Q000502:physiology; D020123:Sirolimus / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D014019:Tissue Donors / Q000145:classification*
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D020123:Sirolimus