title: Sirolimus conversion efficacy for graft function improvement and histopathology in renal recipients with mild to moderate renal insufficiency.
abstract: This study was designed to evaluate whether sirolimus (SRL) conversion effectively improves renal function and histopathology in calcineurin inhibitor (CNI)-treated renal recipients with mild to moderate renal insufficiency. SRL conversion from CNI was performed in patients who underwent kidney transplantation from 6 months to 5 yr prior to screening. Forty-five patients were enrolled. The effect of SRL conversion on graft function was evaluated, and protocol biopsies were performed preconversion and 1 yr after conversion. Overall graft function after SRL conversion gradually improved, and the improvement in renal function was closely associated with the shorter duration of CNI exposure. When we divided the patients by the duration of CNI exposure, the patients with less than 1 yr of CNI exposure demonstrated significant improvement, but patients with a greater than 1 yr CNI exposure did not exhibit significant improvement. In contrast, protocol biopsies demonstrated no significant improvements in the modified "ah" score or other Banff scores after SRL conversion. Furthermore, the duration of CNI treatment prior to SRL conversion was not associated with histological findings 1 yr after SRL conversion. SRL conversion improved graft function in renal recipients with mild to moderate renal insufficiency, but this effect is not accompanied by histological improvement.
authors.affiliation: The Research Institute for Transplantation, Severance Hospital, Yonsei University Health System, Seoul, Korea. ; Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Joo
authors.affiliation: Department of Internal Medicine, Seoul St. Mary Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.affiliation: The Research Institute for Transplantation, Severance Hospital, Yonsei University Health System, Seoul, Korea. ; Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyeon Joo
authors.initials: HJ
authors.lastname: Jeong
authors.affiliation: Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Beom Jin
authors.initials: BJ
authors.lastname: Lim
authors.affiliation: The Research Institute for Transplantation, Severance Hospital, Yonsei University Health System, Seoul, Korea. ; Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Kyu Ha
authors.initials: KH
authors.lastname: Huh
authors.affiliation: Department of Internal Medicine, Seoul St. Mary Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.affiliation: Department of Pathology, Seoul St. Mary Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yeong Jin
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: The Research Institute for Transplantation, Severance Hospital, Yonsei University Health System, Seoul, Korea. ; Department of Internal Medicine, Severance Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.affiliation: The Research Institute for Transplantation, Severance Hospital, Yonsei University Health System, Seoul, Korea. ; Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Yu Seun
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000008:administration & dosage*; D004357:Drug Synergism; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D051437:Renal Insufficiency / Q000175:diagnosis / Q000628:therapy*; D056910:Republic of Korea; D012720:Severity of Illness Index; D020123:Sirolimus / Q000008:administration & dosage*; D023001:Transplantation Tolerance / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus
keywords: Calcineurin Inhibitor; Kidney Transplantation; Renal Function; Renal Impairment; Sirolimus