title: Long-Term Renal Function in Liver Transplant Recipients After Conversion From Calcineurin Inhibitors to mTOR Inhibitors.
abstract: BACKGROUND
  Renal dysfunction often occurs in liver transplant (LT) recipients receiving calcineurin inhibitor (CNI)-based immunosuppressive regimens, increasing morbidity and mortality rates. Replacement of CNIs by mTOR inhibitor-based immunosuppressive protocols may prevent renal impairment in LT recipients.
  
  
  METHODS
  Outcomes in patients who underwent LT between 1996 and 2010 at our center and who were switched from CNI-based to mTOR inhibitor-based immunosuppression were retrospectively analyzed. Renal course, hyperlipidemia, and graft rejection were assessed in patients maintained on this CNI-free regimen for at least 24 months.
  
  
  RESULTS
  Of the 85 patients switched from CNI-based to mTOR inhibitor-based, CNI-free immunosuppression, 78 met the inclusion criteria. Within the first 6 weeks after switching, the covariable adjusted estimated glomerular filtration rate (eGFR) increased 5.6 mL/min [95% confidence interval 2.6-8.7 mL/min, p<0.001], but there were no further statistically noticeable changes in eGFR. Concentrations of cholesterol and triglycerides increased statistically, noticeable within the first 12 months after drug conversion. Histologically proven graft rejection was observed in 4 patients (5.1%) after conversion.
  
  
  CONCLUSIONS
  Conversion from CNI-based to CNI-free, mTOR inhibitor-based immunosuppression after LT is safe and can result in significant renal recovery. CNI-free, mTOR inhibitor-based immunosuppression is a potential option for patients with contraindications for CNIs and for LT recipients with rapid reduction in kidney function due to CNIs.
authors.affiliation: Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Hüsing
authors.affiliation: Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.affiliation: Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Vito R
authors.initials: VR
authors.lastname: Cicinnati
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
authors.forename: Raphael
authors.initials: R
authors.lastname: Koch
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors.forename: Gerold
authors.initials: G
authors.lastname: Thölking
authors.affiliation: Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Stella
authors.affiliation: Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Heinzow
authors.affiliation: Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Hartmut H
authors.initials: HH
authors.lastname: Schmidt
authors.affiliation: Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Iyad
authors.initials: I
authors.lastname: Kabar
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D000068338:Everolimus / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006084:Graft Rejection; D006085:Graft Survival; D006785:Hospitals, University; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D007677:Kidney Function Tests; D016014:Linear Models; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects; D015996:Survival Rate; D058570:TOR Serine-Threonine Kinases / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D013997:Time Factors; D014181:Transplantation Immunology; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus