title: Timing of sirolimus conversion influences recovery of renal function in liver transplant recipients.
abstract: The long-term use of calcineurin inhibitors (CNI) leads to renal dysfunction in many liver transplant (LT) recipients. The purpose of this analysis is to evaluate renal function in patients converted from CNI to sirolimus (SRL). From May 2002-November 2006, 137 LT were performed in 125 patients, 72 of which were converted to SRL. Evaluation of SRL conversion was stratified by early conversion (<90 d from LT) (EC) vs. late conversion (LC). Renal function was evaluated using the six-point modification of diet in renal disease formula (estimated glomerular filtration rate [eGFR]). Forty-two patients on SRL and 40 on CNI had at least three months of follow-up and are included in the eGFR evaluation. At all time points after conversion, the EC group demonstrated a significantly higher mean eGFR than those in the LC group. A significant improvement in eGFR was seen within the EC group when comparing eGFR at time of conversion to eGFR at three, six, nine, and 12 months after conversion and last follow-up. The only improvement in the LC group was from conversion to the three-month time point. We conclude that EC to SRL results in a profound improvement in eGFR that begins at three months and is sustained beyond one yr.
authors.affiliation: Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA. crogers3@bidmc.harvard.edu
authors.forename: Christin C
authors.initials: CC
authors.lastname: Rogers
authors.forename: Scott R
authors.initials: SR
authors.lastname: Johnson
authors.forename: Didier A
authors.initials: DA
authors.lastname: Mandelbrot
authors.forename: Martha
authors.initials: M
authors.lastname: Pavlakis
authors.forename: Timothy
authors.initials: T
authors.lastname: Horwedel
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Karp
authors.forename: Ogo
authors.initials: O
authors.lastname: Egbuna
authors.forename: James R
authors.initials: JR
authors.lastname: Rodrigue
authors.forename: Robyn E
authors.initials: RE
authors.lastname: Chudzinski
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Goldfarb-Rumyantzev
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Hanto
authors.forename: Michael P
authors.initials: MP
authors.lastname: Curry
mesh_terms: D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000187:drug effects*; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus; D016559:Tacrolimus