The effect of sirolimus in the development of chronic allograft nephropathy.
OBJECTIVE
The effect of sirolimus (SRL) in renal function was studied in renal transplant recipients.


METHODS
We studied 20 patients who underwent live related kidney transplantation 1 to 2 years prior under cyclosporine (CsA) treatment and displayed serum creatinine values between 2 and 3 mg/dL. The patients were randomized into 2 groups prospectively. The calcineurin inhibitors (CNI) group continued taking CsA; the SRL group underwent a switch from CsA to SRL. Biopsies were performed to assess chronic allograft nephropathy (CAN) findings and TGFbeta1 in the transplanted kidneys at the beginning and the end of the study. Creatinine clearance, serum creatinine, and proteinuria values were detected in the beginning as well as at 1, 3, 6, and 12 months later.


RESULTS
At the beginning of the study, the creatinine clearance and serum creatinine levels were 52.21 mL/min and 2.05 mg/dL in the CNI group and 47.76 mL/min and 2.13 mg/dL in the SRL group, respectively. At 12 months, these values were 48.11 mL/min and 2.57 mg/dL in the CNI group and 50.45 mL/min and 2.12 mg/dL in the SRL group, respectively. Creatinine clearance values between the 2 groups at 12 months were statistically different. Although it was not significant, there was a tendency toward decreases inflammatory infiltration and TGFbeta1 levels in the SRL group compared with the CNI group on the second biopsies.


CONCLUSIONS
Pathologic findings of CAN development, serum creatinine, and creatinine clearance values were ameliorated in the SRL group. We concluded that SRL positively affected long-term graft survival.
Gürkan
A
A
S.B. Tepecik Teaching Hospital, Organ Transplantation Center, Izmir, Turkey. alpgurkan@superonline.com
Kaçar
S
S
Erdoğdu
U
U
Varilsüha
C
C
Kandemir
G
G
Karaca
C
C
Akman
F
F
D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood / Q000378:metabolism; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology*; D020123:Sirolimus / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents; D003404:Creatinine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D020123:Sirolimus