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Effect of sirolimus withdrawal in patients with deteriorating renal function
Bruce Kaplan1, Jesse Schold, Titte Srinivas
1University of Florida, Gainesville, FL 32610-0224, USA. kaplab@medicine.ufl.edu
Summary
Withdrawing sirolimus in kidney transplant patients with declining renal function improved kidney function by 18%. This immunosuppressive drug adjustment offers a potential strategy to reverse progressive kidney damage.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pharmacology
Background:
- Sirolimus is a key immunosuppressant in kidney transplantation.
- Sirolimus may worsen calcineurin inhibitor (CNI)-induced nephrotoxicity through unclear mechanisms.
- CNI withdrawal can improve renal function in patients on sirolimus.
Purpose of the Study:
- To investigate if sirolimus withdrawal can improve renal function in kidney transplant recipients experiencing deterioration.
- To assess the impact of sirolimus cessation on renal function and related parameters.
Main Methods:
- Retrospective study of 17 kidney transplant patients with declining renal function on CNI and sirolimus.
- Sirolimus was withdrawn and replaced with mycophenolate mofetil.
- Renal function was monitored by the slope of reciprocal serum creatinine (1/Cr).
Main Results:
- 15 out of 17 patients showed improved renal function (positive slope in 1/Cr) after sirolimus withdrawal.
- Overall renal function improved by 18% (creatinine decreased from 2.75 to 2.24 mg/dL).
- Improvements were also observed in LDL cholesterol and hematocrit levels.
Conclusions:
- Withdrawal of sirolimus can reverse progressive renal function deterioration in kidney transplant patients.
- This strategy is a viable option, especially when CNI withdrawal poses high immunologic or metabolic risks.