Interstitial fibrosis quantification in renal transplant recipients randomized to continue cyclosporine or convert to sirolimus.
Conversion from cyclosporine (CsA) to sirolimus at week 12 after kidney transplantation is associated with a significant improvement in renal function. The aim of this analysis was to investigate the effect of this conversion on interstitial fibrosis (IF), a hallmark of chronic allograft injury, in patients taking part in the CONCEPT trial. This multicenter, prospective, trial included 193 renal recipients randomized at week 12 to switch from CsA to sirolimus or to continue CsA, with mycophenolate mofetil. Routine biopsy with automated, quantified assessment of IF by a program of color segmentation was performed at 1 year in 121 patients. At 1 year, renal function was significantly improved in the conversion group as assessed by estimated GFR (MDRD) and measured GFR. Biopsy results, however, showed no between-group difference in percentage of IF. Calculated GFR at 1 year was significantly associated with the percentage of IF (p = 0.004, R(2)= 0.07). By multivariate analysis diabetic patients had more fibrosis than non-diabetic patients. In conclusion, although kidney transplant patients converted from CsA to sirolimus showed significant improvement in renal function, we found no difference of IF on 1-year biopsies.
Departments of Nephrology, Assistance publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France. aude.servais@nck.aphp.fr
A
A
Servais
V
V
Meas-Yedid
O
O
Toupance
Y
Y
Lebranchu
A
A
Thierry
B
B
Moulin
I
I
Etienne
C
C
Presne
de Ligny B
de LB
Hurault
P
P
Le Pogamp
Y
Y
Le Meur
D
D
Glotz
C
C
Hayem
J C
JC
Olivo Marin
E
E
Thervet
D000328:Adult; D001706:Biopsy; D002908:Chronic Disease; D016572:Cyclosporine / Q000008:administration & dosage*; D005260:Female; D005355:Fibrosis; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000008:administration & dosage*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus