title: Long-term outcomes following sirolimus conversion after renal transplantation.
abstract: Long-term outcomes following renal transplantation remain limited due to chronic progressive injury partly as a result of calcineurin inhibitor (CNI) toxicity. Thus, patients have been converted to non-CNI immunosuppressives despite the lack of evidence of long-term benefits from CNI free therapy. We now report our 10-year experience converting patients with well functioning transplants from CNI to sirolimus. We retrospectively analyzed outcomes of patients receiving continuous CNI based therapy (CNI, n = 309) or who were switched to sirolimus within the first year of post-transplantation (CONV, n = 54). The groups were similar for most recipient, graft and donor characteristics, however, diabetes was more common in the CNI group and statin use was more frequent in the CONV group. The average time to conversion was 7.2 months and the creatinine level at the time of switching was 1.4 mg/dl. Ten year graft and patient survival rates were equivalent in both groups. There were no differences in the causes of death or graft loss in both groups. Renal function was available for 5 years posttransplant and was no different between groups. Thus, there is no evidence that routinely switching patients with well functioning renal allografts to sirolimus from CNI based immunosuppression provides long-term benefit.
authors.affiliation: Department of Surgery, Division of Transplantation, State University of New York (SUNY) at Buffalo , Buffalo, NY , USA and.
authors.forename: Karim
authors.initials: K
authors.lastname: Soliman
authors.forename: Emad
authors.initials: E
authors.lastname: Mogadam
authors.forename: Mark
authors.initials: M
authors.lastname: Laftavi
authors.forename: Sunil
authors.initials: S
authors.lastname: Patel
authors.forename: Lin
authors.initials: L
authors.lastname: Feng
authors.forename: Meriem
authors.initials: M
authors.lastname: Said
authors.forename: Oleh
authors.initials: O
authors.lastname: Pankewycz
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D057915:Drug Substitution / Q000706:statistics & numerical data*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D065095:Calcineurin Inhibitors; D020123:Sirolimus
keywords: Calcineurin avoidance; immunosuppressive therapy; kidney transplantation; long-term outcomes