title: Calcineurin inhibitor conversion to rapamycin can improve graft function in living donor kidney transplantation with older donors.
abstract: BACKGROUND
  Recipients of living donor kidney transplantations from older donors often experience a lower glomerular filtration rate (GFR) than those from young donors. Calcineurin inhibitors (CNI) may cause nephrotoxicity, especially in recipients of older donor organs. The aim of this study was to investigate whether CNI withdrawal and conversion to rapamycin improved graft function among transplantation recipients of living donor kidneys from older donors.
  
  
  METHODS
  We collected 83 living donor kidney transplantations using donors aged >50 years from January 2004 to December 2009, including 25 who underwent conversion to rapamycin at the end of 3 months, while 58 cases were maintained on CNI. Baseline characteristics, complications, and graft functions were compared between the groups.
  
  
  RESULTS
  Donor age, recipient age, body weight, human leukocyte antigen mismatch, delayed graft function, acute rejection rate, serum creatinine, and estimated GFR were comparable between the 2 groups at the end of 3 months. The 1-year serum creatinine were 111.8 ± 25.5 μmol/L in CNI withdrawal versus 132.5 ± 35.9 μmol/L in the CNI-maintained group (P = .013) with 1-year estimated GFR of 86.9 ± 8.2 mL/min versus 77.4 ± 7.2 mL/min and 3-year estimated GFR of 76.1 ± 7.8 mL/min versus 67.0 ± 6.4 mL/min, respectively (both P < .001). The rates of acute rejection were 24% versus 22.4%, and chronic rejection, 4.0% versus 10.3% respectively (P > .05). One CNI withdrawal patient (4.0%) lost the graft function while 4 (6.9%) did so in the CNI-maintained group (P > .05). Logistic multivariate regression showed that maintained CNI usage, acute rejection episodes, and female donors to male recipients were independent risk factors for abnormal 1-year serum creatinine levels (P < .05).
  
  
  CONCLUSIONS
  CNI withdrawal with conversion to rapamycin improved graft function in living donor kidney transplantations from older donors.
authors.affiliation: Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: G-D
authors.initials: GD
authors.lastname: Chen
authors.forename: X-C
authors.initials: XC
authors.lastname: Liu
authors.forename: L
authors.initials: L
authors.lastname: Shi
authors.forename: J
authors.initials: J
authors.lastname: Qiu
authors.forename: C-X
authors.initials: CX
authors.lastname: Wang
authors.forename: J-G
authors.initials: JG
authors.lastname: Fei
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: G
authors.initials: G
authors.lastname: Huang
authors.forename: L-Z
authors.initials: LZ
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D003404:Creatinine; D020123:Sirolimus