Living related kidney transplantation without calcineurin inhibitors: initial experience in a Mexican center.
We performed a prospective randomized trial comparing sirolimus/mycophenolate mofetil (MMF)/prednisone to cyclosporine/MMF/prednisone and selected induction therapy with basiliximab. Twenty patients received sirolimus (10 mg loading dose followed by 3 mg/m body surface area/day, keeping 24-hr trough levels at 10-15 ng/mL for six months and 5-10 ng/mL thereafter. Twenty-one patients began cyclosporine (4 to 8 mg/kg/day, keeping 12-hour trough levels at 150-300 ng/mL for 6 months and 100-200 ng/mL afterwards). Mean follow up was 15.8 months. One-year patient and graft survival was similar in both groups (>90%). Acute rejection rate was 16.6% in the sirolimus group and 5.2% in the cyclosporine group (P=NS). There were no differences in mean serum creatinine between groups. No patients who received basiliximab and had sirolimus target levels suffered acute rejection at one year. The sirolimus group had significantly higher cholesterol and triglycerides. A calcineurin inhibitor-free regimen using sirolimus produces comparable one-year transplant outcomes in living related kidney transplants compared to a calcineurin inhibitor regimen.
Martinez-Mier
Gustavo
G
Department of Organ Transplantation, IMSS Adolfo Ruiz Cortines National Medical Center, Veracruz, Mexico. gmtzmier@ver.megared.net.mx
Mendez-Lopez
Marco T
MT
Budar-Fernandez
Luis F
LF
Estrada-Oros
Jorge
J
Franco-Abaroa
Regino
R
George-Micelli
Esteban
E
Rios-Martinez
Luis
L
Mendez-Machado
Gustavo F
GF
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001774:Blood Chemical Analysis; D065095:Calcineurin Inhibitors; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008800:Mexico; D011241:Prednisone / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D011241:Prednisone