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Review of symposium. Sirolimus in kidney transplantation

Francesco P Schena1

  • 1Renal, Dialysis and Transplant Unit, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy. fp.schena@nephro.uniba.it

Transplantation
|April 23, 2009
PubMed

Insights

Sirolimus (SRL), a mTOR inhibitor, offers a non-nephrotoxic immunosuppression option. It is suitable for early post-transplant protocols, conversion therapy, and marginal donor recipients, provided proteinuria is controlled.

Area of Science:

  • Immunology
  • Nephrology
  • Pharmacology

Background:

  • Sirolimus (SRL) is an immunosuppressive drug that inhibits T-cell proliferation via mTOR pathway.
  • Calcineurin inhibitors (CNIs) can exacerbate renal damage in patients with risk factors like age, hypertension, and diabetes.

Purpose of the Study:

  • To outline the potential applications of Sirolimus (SRL) in immunosuppressive protocols.
  • To define patient selection criteria for Sirolimus (SRL) therapy based on proteinuria levels.

Main Methods:

  • Review of clinical applications of Sirolimus (SRL) in transplantation.
  • Analysis of patient eligibility based on proteinuria and creatinine ratios.

Main Results:

  • Sirolimus (SRL) can be used as an early immunosuppressant in CNI-free protocols (first 3 months post-transplant).
  • Sirolimus (SRL) is effective in both early and late conversion protocols, as supported by the CONVERT trial.
  • The drug is beneficial for recipients of marginal donors, mitigating CNI-induced renal damage.

Conclusions:

  • Sirolimus (SRL) presents a valuable non-nephrotoxic alternative to CNIs in specific transplant scenarios.
  • Patient selection for Sirolimus (SRL) requires careful assessment of proteinuria, with a recommended cutoff of <=800 mg/24 hr or a protein-to-creatinine ratio <0.11.

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