title: Impact of sirolimus treatment in kidney allograft recipients with prolonged cold ischemia times: 5-year outcomes.
abstract: OBJECTIVE
  Sirolimus, an effective and non-nephrotoxic immunosuppressant, may have an antiproliferative effect on renal tubular cells and increase their apoptosis, thus hindering the recovery of an injured kidney. The aim of this study was to evaluate the impact of combined sirolimus and cyclosporine therapy on the incidence and duration of delayed graft function and long-term graft function.
  
  
  METHODS
  The study group consisted of 23 renal transplant recipients treated with a sirolimus-cyclosporine-prednisone regimen (sirolimus group). The reference group was composed of 23 patients treated with azathioprine-cyclosporine-prednisone. Because of a long cold ischemia time, all the patients were at high risk of developing delayed graft function.
  
  
  RESULTS
  There was an equal frequency of delayed graft function in the sirolimus group compared with the reference group (39% vs 34.8%). The duration of delayed graft function was longer in sirolimus group compared with the reference group (21.2 +/- 12.2 days vs 6.8 +/- 2.5 days) (P < .004). The serum creatinine level at the 12th month was higher in patients with delayed graft function than it was in the remaining patients, independent of the immunosuppression protocol. One and 5-year graft survival rates were 100% and 87% in the sirolimus group, and 95% and 74% in the reference group. The 5-year patient survival rate was 100% in both groups.
  
  
  CONCLUSIONS
  Sirolimus significantly retards the recovery from posttransplant renal failure, but it does not increase the incidence of delayed graft function. Sirolimus therapy should be initiated after recovery from posttransplant renal failure. Sirolimus treatment is beneficial for long-term graft survival.
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland. maria.boratynska@op.pl
authors.forename: Maria
authors.initials: M
authors.lastname: Boratynska
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Banasik
authors.forename: Dariusz
authors.initials: D
authors.lastname: Patrzalek
authors.forename: Marian
authors.initials: M
authors.lastname: Klinger
mesh_terms: D000328:Adult; D050377:Cold Ischemia; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011239:Prednisolone / Q000008:administration & dosage; D051437:Renal Insufficiency / Q000209:etiology; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects*; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D003404:Creatinine; D020123:Sirolimus