title: Conversion to sirolimus allows preservation of renal function in kidney and kidney-pancreas allograft recipients.
abstract: The major causes of graft failure are chronic allograft nephropathy (CAN) and patient mortality. Sirolimus (SRL) is a powerful immunosuppressant with a less nephrotoxic profile as well as a lower incidence of cancer. The aim of this study was to evaluate the impact of conversion to SRL from calcineurin inhibitor (CNI)-based therapy in kidney (KT) and kidney-pancreas (SPK) allograft recipients. We analyzed renal function, allograft and patient survival, and SRL-associated adverse effects in 93 adult patients (86 KT and 7 SPK), who were converted to SRL between January 2001 and November 2008. The main reason for conversion was CAN (76; 9%) and 52 (7%) were receiving tacrolimus. Conversion occurred at a median 26.2 months. There was a significant improvement in creatinine clearance (CCr) at 6 months after conversion (CCr(baseline) 51.4 vs CCr(6m) 60.4 mL/min; P < .0001), without changes at 12 and 24 months. However, proteinuria increased significantly at 6 months compared with the baseline: 150 mg/24 hours (0-453) versus 0 mg/24 hours (range, 0-309), respectively (P < .0001), but did not progress at 12 or 24 months. At the same time we observed more extensive use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 60/5%; 65/3% and 70/2% at 6, 12, and 24 months. There were no changes in blood pressure control. Cholesterol significantly increased at 6 months (218.2 +/- 37 vs. 186.6 +/- 44 mg/dL; P < .0001). Graft and patient survivals at 4 years were 88% and 95%, respectively. Our experience suggested that conversion to SRL constituted a safe alternative with excellent results in patient and graft survival.
authors.affiliation: CEMIC-IUC University Institute CEMIC, Buenos Aires, Argentina. guslaham@yahoo.com.ar
authors.forename: G
authors.initials: G
authors.lastname: Laham
authors.forename: S
authors.initials: S
authors.lastname: Sleiman
authors.forename: G
authors.initials: G
authors.lastname: Soler Pujol
authors.forename: C
authors.initials: C
authors.lastname: Diaz
authors.forename: M
authors.initials: M
authors.lastname: Dávalos
authors.forename: A
authors.initials: A
authors.lastname: Vilches
mesh_terms: D000328:Adult; D001706:Biopsy; D003404:Creatinine / Q000097:blood / Q000652:urine; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D016035:Pancreas Transplantation / Q000276:immunology* / Q000473:pathology; D011507:Proteinuria; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine; D020123:Sirolimus