title: Sirolimus conversion in liver transplant recipients with calcineurin inhibitor-induced complications: efficacy and safety.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of conversion from calcineurin inhibitors to sirolimus among liver transplant recipients with calcineurin inhibitor-induced complications.
  
  
  METHODS
  After receiving liver transplants, 25 patients with calcineurin inhibitor-induced complications (22 renal dysfunction and 3 new-onset diabetes mellitus) were converted from sirolimus to tacrolimus. The serum creatinine, sirolimus trough level, liver function, acute rejection episodes, and drug-related adverse effects were monitored.
  
  
  RESULTS
  The patients were followed for 12 to 50 months (median, 25 months). The renal function of the 22 patients with renal dysfunction improved after sirolimus conversion. The serum creatinine levels were significantly lower at 3 months after conversion versus before conversion (113.2 ± 21.8 μmol/L vs 163.2 ± 45.3 μmol/L; P < .05). At the end of the follow-up, the average serum creatinine level was 101.9 ± 23.4 μmol/L among the 20 living recipients. Diabetes also was under control in 3 diabetic recipients after the conversion. Four patients experienced episodes of acute rejection, and intravenous steroid bolus therapy was administered in 2 of them. No graft was lost because of acute rejection. The adverse effects of sirolimus included hyperlipidemia (7/25), anemia (8/25), and mouth ulcers (9/25). All these adverse effects were relieved after a short-term symptomatic therapy, and no patient was withdrawn from the conversion trial.
  
  
  CONCLUSIONS
  Sirolimus monotherapy is effective and safe in liver transplant recipients. Conversion to sirolimus was associated with a sustained improvement in renal function and diabetes mellitus without an increased incidence of acute rejection episodes.
authors.affiliation: Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Wei-qiang
authors.initials: WQ
authors.lastname: Ju
authors.forename: Zhi-yong
authors.initials: ZY
authors.lastname: Guo
authors.forename: Wen-hua
authors.initials: WH
authors.lastname: Liang
authors.forename: Lin-wei
authors.initials: LW
authors.lastname: Wu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Tai
authors.forename: An-bin
authors.initials: AB
authors.lastname: Hu
authors.forename: Ming
authors.initials: M
authors.lastname: Han
authors.forename: Xiao-feng
authors.initials: XF
authors.lastname: Zhu
authors.forename: Xiaoshun
authors.initials: X
authors.lastname: He
mesh_terms: D000208:Acute Disease; D000740:Anemia / Q000139:chemically induced; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019226:Oral Ulcer / Q000139:chemically induced; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D003404:Creatinine; D020123:Sirolimus; D016559:Tacrolimus