title: Impact of tacrolimus-sirolimus maintenance immunosuppression on proteinuria and kidney function in pancreas transplant alone recipients.
abstract: BACKGROUND
  Nephrotoxicity is a major complication with immunosuppression regimens used in transplantation. Calcineurin inhibitor-sparing or reduction regimens using sirolimus (SRL) have shown variable success in kidney transplantation. There is limited data on the role of SRL on native kidney function in pancreas transplantation.
  
  
  METHODS
  All patients undergoing pancreas transplantation from 2003 to 2010 were enrolled in this study (n=65). Patient demographic characteristics were identified and divided into two groups: those receiving tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and those maintained on a regimen of Tac and SRL with or without MMF. The slopes for estimated glomerular filtration rate (eGFR), serum creatinine level (sCr), and proteinuria changes over time were assessed between groups. Urine protein and creatinine ratio (uPr/uCr) was used to assess proteinuria.
  
  
  RESULTS
  There was no difference in baseline demographic characteristics. Patients were followed for a median of 3 years. Baseline sCr and eGFR were similar between groups. Differences in uPr/uCr and rate of change in sCr and eGFR were not significant between the groups overall or for any specific time. There was worsening of sCr, eGFR, and uPr/uCr within the groups over the period of study. There were no significant differences when groups were split by age or gender or when the SRL group was split further based on MMF inclusion.
  
  
  CONCLUSIONS
  Our study findings suggest that using a Tac-SRL regimen in patients with pancreas alone transplantation is a safe approach and may not lead to worsening proteinuria and kidney function when compared with regimens using Tac with MMF.
authors.affiliation: Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Praveen
authors.initials: P
authors.lastname: Kandula
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fridell
authors.forename: Tim E
authors.initials: TE
authors.lastname: Taber
authors.forename: Asif
authors.initials: A
authors.lastname: Sharfuddin
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Yaqub
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Phillips
authors.forename: Jeannie
authors.initials: J
authors.lastname: Chen
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mujtaba
mesh_terms: D000328:Adult; D000367:Age Factors; D001706:Biopsy; D003404:Creatinine / Q000652:urine; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015994:Incidence; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D016035:Pancreas Transplantation; D011507:Proteinuria / Q000453:epidemiology*; D012189:Retrospective Studies; D012737:Sex Factors; D020123:Sirolimus / Q000494:pharmacology / Q000627:therapeutic use*; D016559:Tacrolimus / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus