title: Results of 4-year analysis of conversion from calcineurin inhibitors to mTOR inhibitors in renal transplant patients: single-center experience.
abstract: In this retrospective study, 83 patients were accepted. Mammalian target of rapamycin (mTOR) group consisting of 37 patients were converted from calcineurin inhibitors (CNI), and the control group included 46 patients (initially CNI-receiving patients). As a control-match of each mTOR inhibitor patient, the succeeding patient with transplantation who continued CNI therapy was chosen. All patients received CNI, MMF, and prednisolone as an immunosuppressive therapy initially. In comparison of two groups, there was no significant difference between sex, donor organ source, donor organ ischemia time, or mismatches. However, mean age between groups was significantly different (mTOR group: 48.3 ± 12, CNI group: 38.6 ± 11, p < 0.001). Decision of conversion to mTOR inhibitors in 30 patients was made by biopsy. The reasons for conversion were determined as CNI nephrotoxicity in 15 patients, chronic allograft nephropathy in 15 patients, malignancy in 6 patients, and renal artery stenosis in 1 patient. Basal glomerular filtration rates (GFRs) were markedly lower in mTOR group than in CNI group (38.8 mL/min vs. 72.7 mL/min). At the end of 48-month follow-ups, GFR increased from 38 mL/min to 54 mL/min in mTOR group; however, it decreased to 53 mL/min from 72 mL/min in CNI group. There was no difference left between the two groups in GFR after 4-year follow-up. Hyperlipidemia was higher in mTOR group. Acute rejection rates were similar. Cytomegalovirus (CMV) disease was more prevalent in CNI group. Graft failure developed due to secondary reasons, causing mortality in both groups. We suggest that conversion to mTOR inhibitors maintains and improves graft functions well.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Dokuz Eylul University Hospital, Izmir, Turkey. mehmet.sert@deu.edu.tr
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sert
authors.forename: Ali
authors.initials: A
authors.lastname: Celik
authors.forename: Kemal
authors.initials: K
authors.lastname: Kural
authors.forename: Sibel
authors.initials: S
authors.lastname: Ersan
authors.forename: Pinar
authors.initials: P
authors.lastname: Ataca
authors.forename: Koray
authors.initials: K
authors.lastname: Atila
authors.forename: Caner
authors.initials: C
authors.lastname: Cavdar
authors.forename: Aykut
authors.initials: A
authors.lastname: Sifil
authors.forename: Seymen
authors.initials: S
authors.lastname: Bora
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Gulay
authors.forename: Taner
authors.initials: T
authors.lastname: Camsari
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D013997:Time Factors
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D058570:TOR Serine-Threonine Kinases