title: Early Sirolimus Conversion as Rescue Therapy in Kidneys With Prolonged Delayed Graft Function in Deceased Donor Renal Transplant.
abstract: BACKGROUND
  Increasing rate of delayed graft function (DGF) is seen with the use of Donation after circulatory death (DCD) and extended criteria donor (ECD) kidneys. Use of calcineurin inhibitors (CNIs) may add to insult by causing acute and chronic nephrotoxicity ultimately leading to primary non-function (PNF). We report our experience of early sirolimus (SRL) conversion in such cases in an attempt to salvage graft function.
  
  
  METHODS
  Retrospective study to analyze the impact of early conversion of SRL in patients with prolonged DGF. Two groups were identified: a study (SRL) group with 14 patients and a historic control (CNI) group with 28 patients case-matched based on donor and recipient characteristics.
  
  
  RESULTS
  SRL group included 8 ECD donors with mean DGF duration of 42.3 ± 38.3 days and were converted to SRL 46.6 ± 20.6 days post-transplantation. CNI group had DGF duration of 26.5 ± 9.9 days (P = .03). Mean recipient eGFR (mL/min per 1.73 m(2)) was 12.2 ± 4.3 pre-SRL and 26.0 ± 11.5, 34.1 ± 17.3 and 28.6 ± 14.3 at 3, 12 and 24 months post-SRL conversion respectively. Seven patients achieved sustained good graft function (mean Cr at 1 year of 140 μmol/L). The mean eGFR of the case-matched control group was 31.7 ± 11.7, 36.3 ± 14.1, and 34.9 ± 13.9 over the same time period (P = .104, .540, and .217).
  
  
  CONCLUSIONS
  Conversion to SRL in patients with prolonged DGF may help salvage renal graft function and achieve long-term graft survival in some cases where conventional treatment has failed. We suggest a prospective study of this targeted group to validate such benefit.
authors: Division of Surgery, Department of Transplantation, St James's University Hospital, NHS Trust, Leeds, United Kingdom.
authors: W
authors: W
authors: Tahir
authors: Division of Surgery, Department of Transplantation, St James's University Hospital, NHS Trust, Leeds, United Kingdom.
authors: A
authors: A
authors: Hakeem
authors: Division of Surgery, Department of Transplantation, St James's University Hospital, NHS Trust, Leeds, United Kingdom.
authors: M
authors: M
authors: Dawrant
authors: Department of Histopathology, St James's University Hospital, NHS Trust, Leeds, United Kingdom.
authors: P
authors: P
authors: Prasad
authors: Department of Pharmacology, St James's University Hospital, NHS Trust, Leeds, United Kingdom.
authors: M
authors: M
authors: Lee
authors: Division of Surgery, Department of Transplantation, St James's University Hospital, NHS Trust, Leeds, United Kingdom.
authors: K
authors: K
authors: Menon
authors: Division of Surgery, Department of Transplantation, St James's University Hospital, NHS Trust, Leeds, United Kingdom.
authors: M
authors: M
authors: Attia
authors: Department of Renal Medicine, St James's University Hospital, NHS Trust, Leeds, United Kingdom.
authors: R
authors: R
authors: Baker
authors: Division of Surgery, Department of Transplantation, St James's University Hospital, NHS Trust, Leeds, United Kingdom. Electronic address: niaz.ahmad@leedsth.nhs.uk.
authors: N
authors: N
authors: Ahmad
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D051799:Delayed Graft Function / Q000188:drug therapy*; D005260:Female; D006323:Heart Arrest; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D020123:Sirolimus / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus