title: Sirolimus monotherapy as maintenance immunosuppression: single-center experience in 50 kidney transplant patients.
abstract: BACKGROUND
  Chronic allograft nephropathy, cardiovascular mortality, and posttransplant malignancy are complications of conventional immunosuppression after kidney transplantation. We reported the feasibility of maintenance monotherapy with sirolimus (SRL) in a pilot experience. The aim was to study safety and feasibility of SRL maintenance monotherapy in 50 kidney transplant patients.
  
  
  METHODS
  All patients from our center with at least 6 months follow-up on SRL monotherapy were included. During the first month after start of SRL monotherapy, follow-up visits were performed weekly, then each month for the following 2 months. Each follow-up visit included a physical exam and laboratory screening.
  
  
  RESULTS
  Mean follow-up on SRL monotherapy was 34.7 +/- 14.9 months. The time between transplantation until start of monotherapy was 7.7 +/- 3.3 years. No rejections occurred. During follow-up, two patients died of cardiovascular disease (already diagnosed before monotherapy); one, of previously diagnosed posttransplant malignancy and one, of hepatitis C-related liver failure. Glomerular filtration rate (GFR) was 53 mL/min x 1.73 m2 at start of monotherapy and 50 mL/min x 1.73 m2 after 4 years. Proteinuria was 632 +/- 562 mg/24 hours at 4 years. During the follow-up, no significant changes in the lipid profile, glycemia, or hemoglobin occurred.
  
  
  CONCLUSIONS
  Sirolimus monotherapy is safe in a selected group of immunological low-risk patients without increasing the risk of rejection.
authors: Department of Nephrology and Renal Transplantation, Hospital Clinic, Barcelona, Spain. emarceloat@yahoo.com.mx
authors: E M
authors: EM
authors: Arellano
authors: J M
authors: JM
authors: Campistol
authors: F
authors: F
authors: Oppenheimer
authors: J
authors: J
authors: Rovira
authors: F
authors: F
authors: Diekmann
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D020123:Sirolimus / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus