title: Conversion from calcineurin inhibitor to sirolimus for renal function deterioration in kidney allograft recipients.
abstract: BACKGROUND
  Calcineurin inhibitors play an important role in chronic allograft dysfunction. Sirolimus is an interesting alternative in renal transplant patients because it is less nephrotoxic than calcineurin inhibitors.
  
  
  METHODS
  A chart review of the clinical outcome of kidney transplant patients converted to sirolimus with progressive allograft dysfunction is reported herein. Fifteen patients (average age: 32.3 years, 44 months mean time of conversion) were included. Indication for conversion was a >20% increase in serum creatinine over the last 6 months or progression to the range of 2-4.5 mg/dL. Patients underwent abrupt cessation of cyclosporine and sirolimus addition at 2-5 mg/day.
  
  
  RESULTS
  Concomitant immunosuppression remained unchanged during conversion. Targeted sirolimus level was 8-12 ng/mL. Serum creatinine dropped from pre-conversion level of 2.75 +/- 0.83 to 2.14 +/- 0.67 and 1.97 +/- 0.66 mg/dL at 3 and 6 months (p <0.05). There was a significant decrease in blood urea nitrogen, hemoglobin and serum calcium at 3 months post-conversion as well as serum calcium and potassium at 6 months post-conversion (p <0.05). There were no rejection episodes. Patient and graft survival was 100% with three infectious complications.
  
  
  CONCLUSIONS
  Monitored sirolimus conversion with sharp withdrawal of calcineurin inhibitor is an alternative for patients with deteriorating renal function and chronic allograft nephropathy.
authors.affiliation: Department of Organ Transplantation, School of Medicine, Universidad Cristobal Colon, Veracruz, Mexico. gmtzmier@ver.megared.net.mx
authors.forename: Gustavo
authors.initials: G
authors.lastname: Martínez-Mier
authors.forename: Marco Tulio
authors.initials: MT
authors.lastname: Méndez-López
authors.forename: Jorge
authors.initials: J
authors.lastname: Estrada-Oros
authors.forename: Luis F
authors.initials: LF
authors.lastname: Budar-Fernandez
authors.forename: Juan I
authors.initials: JI
authors.lastname: Soto-González
authors.forename: Gustavo F
authors.initials: GF
authors.lastname: Méndez-Machado
authors.forename: Julio Cesar
authors.initials: JC
authors.lastname: Viñas Dozal
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D007676:Kidney Failure, Chronic / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D016030:Kidney Transplantation; D008297:Male; D008991:Monitoring, Physiologic; D011188:Potassium / Q000097:blood; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage* / Q000493:pharmacokinetics; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
chemical_list: D065095:Calcineurin Inhibitors; D004791:Enzyme Inhibitors; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D014508:Urea; D003404:Creatinine; D011188:Potassium; D002118:Calcium; D020123:Sirolimus