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Published on: November 8, 2015
Sirolimus as primary immunosuppression agent in kidney transplant recipients: Akdeniz University experience
G U Karatas1, U Yakupoglu, Y K Yakupoglu
1Akdeniz University Organ Transplantation Center, Antalya, Turkey.
Objectives:
Recently usage of sirolimus as the primary immunosuppressant is widening among kidney transplant recipients. We reviewed the clinical follow-up of patients transplanted at our center using sirolimus protocols.
Methods:
Sirolimus including primary immunosuppressive treatment protocols were begun in February 2002. Among the 21 patients (15 men, six women) who received sirolimus, six patients were prescribed sirolimus + prednisolone; seven, sirolimus + mycophenolate mofetil + prednisolone; and eight, sirolimus + cyclosporine + prednisolone. The mean age of the patients was 32.9 +/- 7.3 years and the mean posttransplantation follow-up, 13.2 +/- 4.5 months.
Results:
Three patients experienced acute rejection episodes, which were treated successfully with steroids. None of the patients had either hematologic or wound healing problems. Lymphoceles developed in eight patients. Serum creatinine level was 1.4 +/- 0.5 mg/dL at 12 months. There was a serious increase in serum cholesterol and triglyceride levels starting from the first month posttransplant (total cholesterol levels pretransplant and at 1 month, respectively: 159.3 +/- 29.5 and 255.7 +/- 52.3 mg/dL, P = .0001; triglycerides pretransplant and at 1 month, respectively: 146.9 +/- 89.5 and 215.1 +/- 102.5 mg/dL, P = .001). Despite routine antihyperlipemic treatment those high levels were maintained for 12 months.
Conclusions:
We achieved 100% graft and patient survival rates for 1 year among patients who were using sirolimus. But the most important role in defining the morbidity and mortality in this group of patients is cardiovascular events; for this reason the abnormalities in the lipid profile must be taken seriously.
Insights
Sirolimus use in kidney transplants shows 100% graft survival at one year. However, significant lipid profile abnormalities require careful monitoring due to cardiovascular risks.
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- Sirolimus is increasingly used as a primary immunosuppressant in kidney transplant recipients.
- Understanding the clinical outcomes and potential side effects of sirolimus-based protocols is crucial.
Purpose of the Study:
- To review the clinical follow-up of kidney transplant patients treated with sirolimus-based immunosuppression.
- To evaluate graft and patient survival rates, as well as adverse events associated with sirolimus therapy.
Main Methods:
- A retrospective review of 21 kidney transplant recipients treated with sirolimus-based protocols since February 2002.
- Patients received varying combinations of sirolimus with prednisolone, mycophenolate mofetil, or cyclosporine.
- Mean follow-up was 13.2 months.
Main Results:
- 100% graft and patient survival at one year was observed.
- No hematologic or wound healing issues were reported.
- Eight patients developed lymphoceles.
- Significant increases in serum cholesterol and triglycerides were noted by month one and persisted despite treatment.
- Serum creatinine remained stable at 1.4 +/- 0.5 mg/dL at 12 months.
Conclusions:
- Sirolimus-based immunosuppression achieved excellent short-term graft and patient survival in kidney transplantation.
- Adverse lipid profile changes are a significant concern and necessitate serious attention due to potential cardiovascular implications.
- Monitoring and management of hyperlipidemia are critical for long-term outcomes in these patients.
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