title: Conversion to sirolimus in pediatric renal transplant patients: a single-center experience.
abstract: We studied efficacy and safety of conversion from CNI- to SRL-based immunosuppression in 92 kidney TX recipients, mainly due to CAN (69%). Median time of conversion was 31 months (r: 0.3-165); median time of follow-up: 36 months (r: 2-102). In the whole group mean eGFR increased from 53 ± 22 to 67 ± 26mL/min/1.73 m(2) at three months (p = 0.02) and did not change subsequently. Patients with grade I CAN had higher eGFR than those with grade II CAN. Patient and graft survival was 96% and 70% 10 yr after conversion. Patients with grade I CAN had better graft survival than those with grade II CAN: 89% vs. 65% at six yr (p = 0.02) post conversion. There were two episodes of BPAR. Baseline proteinuria >20 mg/kg/day (HR: 10) and baseline eGFR <50 mL/min/1.73 m(2) (HR: 8) were independent predictors of graft loss. Sixty-seven of 92 subjects had ≥1 AEs: diarrhea (n = 52), urinary tract infections (n = 35), and lower respiratory tract infections (n = 12) were the most frequent. Patients with >2 AEs had SRL blood levels >9 ng/mL at month 3 (p = 0.01). In conclusion, patients converted from CNI to SRL had good graft survival and tolerable but frequent AEs. Independent predictors of graft loss were baseline proteinuria and eGFR.
authors.affiliation: Hospital de Pediatría J P Garrahan, Buenos Aires, Argentina. martamonteverde@gmail.com
authors.forename: Marta L
authors.initials: ML
authors.lastname: Monteverde
authors.forename: Juan
authors.initials: J
authors.lastname: Ibañez
authors.forename: Ziomara
authors.initials: Z
authors.lastname: Balbarrey
authors.forename: Alicia
authors.initials: A
authors.lastname: Chaparro
authors.forename: Mario
authors.initials: M
authors.lastname: Diaz
authors.forename: Amalia
authors.initials: A
authors.lastname: Turconi
mesh_terms: D001706:Biopsy; D065095:Calcineurin Inhibitors; D002648:Child; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000379:methods*; D008055:Lipids / Q000097:blood; D008297:Male; D010372:Pediatrics / Q000379:methods; D011507:Proteinuria / Q000175:diagnosis; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D008055:Lipids; D003404:Creatinine; D020123:Sirolimus