Initial single-center experience with sirolimus after lung transplantation.
BACKGROUND
Standard immunosuppression after lung transplantation includes calcineurin inhibitors, mycophenolate mofetil, and steroids. Long-term survivors of lung transplantation are often confronted with chronic kidney disease, by definition related to the intake of calcineurin inhibitors. Sirolimus has been increasingly proposed as an alternative immunosuppressive agent due to its absence of nephrotoxicity, which could be used in selected patients.


METHODS
We prospectively administered sirolimus as an alternative to calcineurin inhibitors in 10 lung transplantation recipients with persistent drug nephrotoxicity. They were switched from tacrolimus to sirolimus. Four patients also had bronchiolitis obliterans syndrome. The conversion scheme consisted of an immediate stop of tacrolimus and an 6 to 8-mg loading dose of sirolimus, followed by 4 mg/d. After 5 days, the sirolimus dose was adjusted to maintain trough levels between 12 and 18 ng/mL or 6 and 12 ng/mL for combined sirolimus and tacrolimus. Patients were monitored for renal and graft function as well as clinical status.


RESULTS
A significant decrease in creatinine was observed after 1 week of treatment (P = .011). Azotemia decreased after 1 month, remaining stable (P < .01). Pulmonary function tests did not show significant modification from before sirolimus, inception in patients with or without bronchiolitis obliterans syndrome. There were seven infections. One patient died of complications related to bronchiolitis obliterans.


CONCLUSIONS
Sirolimus was a useful alternative immunosuppressant, allowing significant tacrolimus withdrawal in transplant recipients with renal impairment. Sirolimus administration allowed recovery of renal function with low morbidity; it was useful for rescue of chronic renal impairment after lung transplantation.
Lischke
R
R
3rd Department of Surgery, Thoracic and Lung Transplantation Division, University Hospital Motol, Prague, Czech Republic. robert.lischke@seznam.cz
Simonek
J
J
Matousovic
K
K
Stolz
A J
AJ
Schützner
J
J
Vojácek
J
J
Burkert
J
J
Davidová
R
R
Pafko
P
P
D001989:Bronchiolitis Obliterans / Q000150:complications; D003404:Creatinine / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000276:immunology*; D020123:Sirolimus / Q000627:therapeutic use*; D017741:Survivors; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D003404:Creatinine; D020123:Sirolimus; D016559:Tacrolimus