title: Immunosuppressive switch to sirolimus in renal dysfunction after liver transplantation.
abstract: OBJECTIVE
  Nephrotoxicity is a serious adverse effect after liver transplantation often related to calcineurin inhibitors (CNI) with a incidence of 18.1% at 5 years. Sirolimus (SRL) is a new immunosuppressive drug that was introduced into solid organ transplant management in 1999. Herein we have performed a retrospective review of patients who developed renal insufficiency owing to CNI therapy after orthotopic liver transplantation (OLT).
  
  
  METHODS
  Thirty-one patients were switched to SRL monotherapy because of nephrotoxicity as evidenced by serum creatinine levels (SCr) > 1.8 mg/dL and estimated glomerular filtration rates (eGFR) < 45 mL/min/1.73 m(2). The dosage was adjusted to achieve trough levels between 8 and 10 ng/mL.
  
  
  RESULTS
  The patients were followed for a mean of 52 months (range 2-88 months) after OLT. Mean follow-up after the switch was 27.5 months (range, 2-71.2 months). Immunosuppression was switched after a mean of 35.2 months (range, 0.2-43.4 months). Renal function was significantly improved, as shown by the improved SCr, urea, and eGFR after the switch.
  
  
  CONCLUSIONS
  CNIs may be associated with significant nephrotoxicity and chronic kidney damage. Patients who develop renal dysfunction after OLT may be successfully treated by an early switch from CNIs to SRL, stopping the progression toward chronic renal damage and preserving allograft survival.
authors.affiliation: Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Modena, Italy. f.diben@virgilio.it
authors.forename: F
authors.initials: F
authors.lastname: Di Benedetto
authors.forename: S
authors.initials: S
authors.lastname: Di Sandro
authors.forename: N
authors.initials: N
authors.lastname: De Ruvo
authors.forename: R
authors.initials: R
authors.lastname: Montalti
authors.forename: G P
authors.initials: GP
authors.lastname: Guerrini
authors.forename: R
authors.initials: R
authors.lastname: Ballarin
authors.forename: M
authors.initials: M
authors.lastname: Spaggiari
authors.forename: A
authors.initials: A
authors.lastname: Mimmo
authors.forename: G
authors.initials: G
authors.lastname: D'Amico
authors.forename: N
authors.initials: N
authors.lastname: Cautero
authors.forename: R M
authors.initials: RM
authors.lastname: Iemmolo
authors.forename: G E
authors.initials: GE
authors.lastname: Gerunda
mesh_terms: D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007668:Kidney / Q000503:physiopathology*; D016031:Liver Transplantation / Q000009:adverse effects*; D020123:Sirolimus / Q000008:administration & dosage*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus