title: Long-term effects on renal function of dose-reduced calcineurin inhibitor and sirolimus in cardiac transplant patients.
abstract: Calcineurin inhibitor (CNI)-associated renal insufficiency is common after cardiac transplantation (CTX); however, the addition of sirolimus allows for CNI dose reduction and this strategy may limit CNI renal toxicity. This study examines the long-term effects of such a strategy.
  
  
  METHODS
  Patients from a single center who had CTX from 1990 to 2007 and who were converted to sirolimus and a dose-reduced CNI were compared to group-matched controls maintained on CNI and an antiproliferative agent.
  
  
  RESULTS
  One hundred and fifty-five patients (79 sirolimus and 76 controls) were included and had similar baseline characteristics. Sirolimus was started a mean of 1429 d post-CTX and maintained for a mean of 823 d. Reason for conversion to sirolimus was renal insufficiency (34%), vasculopathy (29%), recurrent rejection (19%), and other (18%). The eGFR was not different between groups at baseline (44.7 mL/min/1.73 m(2) vs. 46.0, p = 0.64) or at any point during follow-up: 90 d, 180 d, 1 yr, 2 yr, and 3 yr. conclusion: Patients converted to a regimen of sirolimus and a dosed-reduced CNI have stable renal function over the following three yr, but do not have an improvement in renal outcomes compared to patients maintained on full dose CNI.
authors.affiliation: Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Sameer J
authors.initials: SJ
authors.lastname: Khandhar
authors.forename: Hemal V
authors.initials: HV
authors.lastname: Shah
authors.forename: Michael A
authors.initials: MA
authors.lastname: Shullo
authors.forename: Rachelle
authors.initials: R
authors.lastname: Zomak
authors.forename: Michelle
authors.initials: M
authors.lastname: Navoney
authors.forename: Dennis M
authors.initials: DM
authors.lastname: McNamara
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Teuteberg
mesh_terms: D065095:Calcineurin Inhibitors; D016022:Case-Control Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000517:prevention & control*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000209:etiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D013995:Time
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus