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Conversion from calcineurin inhibitor to sirolimus for renal function deterioration in kidney allograft recipients
Gustavo Martínez-Mier1, Marco Tulio Méndez-López, Jorge Estrada-Oros
1Department of Organ Transplantation, School of Medicine, Universidad Cristobal Colon, Veracruz, Mexico. gmtzmier@ver.megared.net.mx
Background:
Calcineurin inhibitors play an important role in chronic allograft dysfunction. Sirolimus is an interesting alternative in renal transplant patients because it is less nephrotoxic than calcineurin inhibitors.
Methods:
A chart review of the clinical outcome of kidney transplant patients converted to sirolimus with progressive allograft dysfunction is reported herein. Fifteen patients (average age: 32.3 years, 44 months mean time of conversion) were included. Indication for conversion was a >20% increase in serum creatinine over the last 6 months or progression to the range of 2-4.5 mg/dL. Patients underwent abrupt cessation of cyclosporine and sirolimus addition at 2-5 mg/day.
Results:
Concomitant immunosuppression remained unchanged during conversion. Targeted sirolimus level was 8-12 ng/mL. Serum creatinine dropped from pre-conversion level of 2.75 +/- 0.83 to 2.14 +/- 0.67 and 1.97 +/- 0.66 mg/dL at 3 and 6 months (p <0.05). There was a significant decrease in blood urea nitrogen, hemoglobin and serum calcium at 3 months post-conversion as well as serum calcium and potassium at 6 months post-conversion (p <0.05). There were no rejection episodes. Patient and graft survival was 100% with three infectious complications.
Conclusions:
Monitored sirolimus conversion with sharp withdrawal of calcineurin inhibitor is an alternative for patients with deteriorating renal function and chronic allograft nephropathy.
Insights
Switching kidney transplant patients from calcineurin inhibitors to sirolimus improved renal function. This conversion strategy demonstrated effective management of chronic allograft dysfunction with excellent patient and graft survival.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation
Background:
- Calcineurin inhibitors are crucial for managing chronic allograft dysfunction.
- Sirolimus offers a less nephrotoxic alternative for renal transplant recipients.
Purpose of the Study:
- To evaluate the clinical outcomes of kidney transplant patients converted from calcineurin inhibitors to sirolimus due to progressive allograft dysfunction.
- To assess the efficacy and safety of sirolimus as a replacement therapy in managing chronic allograft nephropathy.
Main Methods:
- A chart review was conducted on fifteen kidney transplant patients converted to sirolimus.
- Conversion involved abrupt cessation of cyclosporine and initiation of sirolimus (2-5 mg/day), maintaining other immunosuppressants.
- Patients had a >20% increase in serum creatinine or levels between 2-4.5 mg/dL.
Main Results:
- Serum creatinine levels significantly decreased at 3 and 6 months post-conversion (p <0.05).
- Significant reductions in blood urea nitrogen, hemoglobin, serum calcium, and potassium were observed.
- Patient and graft survival rates were 100%, with three infectious complications reported.
Conclusions:
- Sirolimus conversion is a viable alternative for patients with declining renal function and chronic allograft nephropathy.
- Careful monitoring of sirolimus levels and abrupt calcineurin inhibitor withdrawal are key to successful conversion.
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