title: Kidney transplant histology after one year of continuous therapy with sirolimus compared with tacrolimus.
abstract: Analysis of 1-year surveillance biopsies was carried out for kidney transplant recipients participating in a randomized trial comparing tacrolimus- and sirolimus-based immunosuppression. The analysis was restricted to recipients remaining on assigned regimen throughout the first posttransplant year. Biopsies from 57 of 84 (68%) tacrolimus-randomized recipients were compared with 38 of 81 (47%) of sirolimus-randomized recipients, the discrepancy being explained by a higher rate of sirolimus discontinuation for non-graft-related complications. Included recipients from the two groups did not differ for baseline characteristics or 1-year iothalamate clearance. Histologic analysis indicated no differences between the groups for glomerular, arterial/arteriolar, or acute interstitial abnormalities. There were, however, significantly higher mean scores in the tacrolimus group for interstitial fibrosis and tubular atrophy with a trend toward higher estimated percent interstitial fibrosis. The results indicate that sirolimus may be associated with reduced early graft fibrosis compared with tacrolimus. This potential benefit is offset by lower success rate in maintaining the regimen and was not accompanied by superior glomerular filtration rate at 1 year.
authors.affiliation: 1 Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. dean.patrick2@mayo.edu
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Dean
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Grande
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sethi
authors.forename: Walter D
authors.initials: WD
authors.lastname: Park
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Griffin
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Cosio
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Larson
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005355:Fibrosis; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus