title: Long-term results after conversion from calcineurin inhibitors to sirolimus in renal transplant patients.
abstract: BACKGROUND
  Calcineurin inhibitors (CNI) toxicity is one of the contributing factors for the development and progression of chronic allograft dysfunction (CAD). Conversion to sirolimus (SRL) from CNI improves renal function kidney in transplant recipients.
  
  
  METHODS
  A retrospective review from patients abruptly converted from CNI to SRL over a three yr period is reported.
  
  
  RESULTS
  Thirty-nine patients were converted 55.2±58 months after renal transplantation. 24 month patient and graft survival was 100% and 92%. Acute rejection incidence was 7.6%. Overall, serum creatinine (SCr) and Cockcroft-Gault creatinine clearance (CGCrCl) improved. In responders, SCr improved from 2.48±0.8 to 1.94±0.8 mg/dL (p<0.05) CGCrCl improved from 37.8±17.4 to 51.9±23.8 mL/min at two years. An increase in proteinuria was observed from conversion to month 12 in responders (189.4±512.8 to 488.3±890.6 mg/day, p<0.05) and from conversion to month six in non-responders (1179.4±2001.1 to 2357±4172.9 mg/day, p<0.05). Low proteinuria had positive predictive value for renal response after conversion.
  
  
  CONCLUSIONS
  Conversion from CNI to SRL with CAD is associated with improved renal function with an increase in proteinuria. Low proteinuria is a possible positive predictive factor for successful conversion.
authors.affiliation: Department of Organ Transplantation, IMSS Adolfo Ruiz Cortines National Medical Center, Hospital General de Veracruz, and Department of Research, School of Medicine, Universidad Cristobal Colon, Veracruz, Mexico. gmtzmier@hotmail.com
authors.forename: Gustavo
authors.initials: G
authors.lastname: Martinez-Mier
authors.forename: Sandro F
authors.initials: SF
authors.lastname: Avila-Pardo
authors.forename: Marco T
authors.initials: MT
authors.lastname: Mendez-Lopez
authors.forename: Luis F
authors.initials: LF
authors.lastname: Budar-Fernandez
mesh_terms: D000293:Adolescent; D000328:Adult; D065095:Calcineurin Inhibitors; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus