Sirolimus as primary immunosuppressant for calcineurin inhibitor-related renal insufficiency after liver transplantation.
BACKGROUND
Calcineurin inhibitor-related renal toxicity affects patient and graft survival in transplant recipients. This study aimed to determine whether sirolimus is effective and safe in treating renal insufficiency related to tacrolimus after liver transplantation.


METHODS
Tacrolimus for primary immunosuppression was used in 16 patients after liver transplantation. Patients with a creatinine level higher than 132.6 micromol/L were eligible for conversion to sirolimus. Simultaneously, the dose of tacrolimus was decreased to half. Blood urea nitrogen, creatinine, tacrolimus level, liver function and rejection episodes were monitored dynamically.


RESULTS
All patients showed improvement of renal function after conversion to sirolimus. Blood creatinine level was reduced from 146.8+/-92.4 to 105.3+/-71.3 micromol/L (P<0.05). One patient had an acute rejection episode that was successfully treated with pulsed corticosteroids and low-dose tacrolimus. The side-effects of sirolimus included hyperlipidemia (4 patients) and leukocytopenia (2).


CONCLUSIONS
Sirolimus can be safely used in liver transplant recipients suffering from tacrolimus-related renal insufficiency.
Yang
Yong-Jiu
YJ
Department of Hepatobiliary Surgery, Beijing Transplantation Center, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing 100020, China.
Li
Li-Xin
LX
He
Qiang
Q
Fan
Hua
H
Jin
Zhong-Kui
ZK
Lang
Ren
R
Kou
Jian-Tao
JT
Li
Peng
P
Xie
De-Hong
DH
Chen
Da-Zhi
DZ
D000328:Adult; D019703:Calcineurin / Q000009:adverse effects* / Q000633:toxicity; D003404:Creatinine / Q000097:blood; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects*; D007674:Kidney Diseases / Q000139:chemically induced*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced*; D020123:Sirolimus / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D003404:Creatinine; D019703:Calcineurin; D020123:Sirolimus; D016559:Tacrolimus