title: Management of chronic allograft dysfunction by switch over to rapamycin.
abstract: The aim of this study was to evaluate the efficacy of conversion from calcineurin inhibitors (CNI)-based to a rapamycin-based immunosuppressive regimen in renal transplant recipients who had allograft dysfunction, in a South Indian population. We analyzed the results of 75 (19.5%) of the 398 renal transplants performed over a five-year period from 2002 to 2007, who were converted from a CNI-based immunosuppression to rapamycin including patients with chronic allograft dysfunction, chronic allograft injury and malignancy. The data analyzed included serial rapamycin levels, serum creatinine, eGFR by nankivel formula, lipid profile, hemoglobin and serum potassium levels. Statistical analysis was performed using student's t test and the Kaplan Meir survival curve was used to predict probability of survival among patients on rapamycin. The mean age of the study patients was 39.6 + or - 12.2 yrs and there was a male predominance (74.6%). Diabetic nephropathy was the predominant cause (36%) of end-stage renal disease (ESRD). Statistical analysis revealed a significant improvement in GFR of 14.6 mL/min and decrease in potassium by 0.7 mmol/L after initiation of rapamycin. There were no significant differences in terms of lipid profile, platelet count, hemoglobin and urine albumin levels. Rapamycin was discontinued in one patient due to hypokalemic nephropathy and in another patient due to delayed wound healing. To our knowledge, this is the first study to provide information on the conversion from a CNI to rapamycin-based immunosuppression in a cohort of Indian renal transplant recipients. In conclusion, the findings of our study confirm that rapamycin-based immunosuppressive regimen improves renal function and graft survival with minimal side effects, in comparison to CNI-based immunosuppression.
authors.affiliation: Department of Nephrology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors.forename: Varun
authors.initials: V
authors.lastname: Sundaram
authors.forename: Georgi
authors.initials: G
authors.lastname: Abraham
authors.forename: Nusrath
authors.initials: N
authors.lastname: Fathima
authors.forename: Vivek
authors.initials: V
authors.lastname: Sundaram
authors.forename: Yogesh N V
authors.initials: YN
authors.lastname: Reddy
authors.forename: Milly
authors.initials: M
authors.lastname: Mathew
authors.forename: Vijaiaboobbathi
authors.initials: V
authors.lastname: Sathiah
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D065095:Calcineurin Inhibitors; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006085:Graft Survival / Q000187:drug effects*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D065095:Calcineurin Inhibitors; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D008055:Lipids; D003404:Creatinine; D011188:Potassium; D020123:Sirolimus