title: Chronic allograft nephropathy score before sirolimus rescue predicts allograft function in renal transplant patients.
abstract: Chronic allograft nephropathy (CAN) is a major indication for initiation of sirolimus (SRL) in renal transplantation (TX) to prevent deterioration of renal function. We evaluated whether the CAN score at time of sirolimus rescue (SRL-R) predicts renal allograft function. CAN score is the sum of the following 4 categories: glomerulopathy (cg, 0-3), interstitial fibrosis (ci, 0-3), tubular atrophy (ct, 0-3), and vasculopathy (cv, 0-3). This is a retrospective cohort study of renal transplant recipients from July 2001 to March 2004. Immunosuppression consisted of preconditioning with rabbit anti-thymocyte globulin or alemtuzumab and maintenance with tacrolimus (TAC) monotherapy with spaced weaning, if applicable, SRL-R was achieved by conversion from TAC, or by addition to reduced doses of TAC. Ninety patients received SRL. Thirty-three of these patients met the inclusion criteria of the following: (1) receipt of SRL for >6 months, and (2) follow-up of > or =6 months. There were 16 patients in the low-CAN (0-4) group and 17 patients in the high-CAN (>4) group. Cockcroft-Gault (C-G) glomerular filtration rate (GFR) was calculated at SRL-R and at 1, 3, 6, and 12 months. The DeltaGFR was significantly better in the low-CAN group at 1, 3, and 6 months. A trend toward an improved DeltaGFR was present at 12 months in the low-CAN group (P = .16). CAN scoring at the time of SRL-R predicts recovery of renal allograft function (as measured using DeltaGFR), and should be used in preference to biochemical markers (Cr and C-G GFR), which may not be reliable predictors.
authors.affiliation: Thomas E Starzl Transplantation Institute, Pittsburgh, PA 15213, USA.
authors.forename: A
authors.initials: A
authors.lastname: Basu
authors.forename: J L
authors.initials: JL
authors.lastname: Falcone
authors.forename: H P
authors.initials: HP
authors.lastname: Tan
authors.forename: D
authors.initials: D
authors.lastname: Hassan
authors.forename: I
authors.initials: I
authors.lastname: Dvorchik
authors.forename: K
authors.initials: K
authors.lastname: Bahri
authors.forename: N
authors.initials: N
authors.lastname: Thai
authors.forename: P S
authors.initials: PS
authors.lastname: Randhawa
authors.forename: A
authors.initials: A
authors.lastname: Marcos
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
authors.forename: R
authors.initials: R
authors.lastname: Shapiro
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum; D002908:Chronic Disease; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology* / Q000473:pathology*; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000276:immunology / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; C512542:thymoglobulin; D020123:Sirolimus