Related Experiment Video
Updated: May 10, 2026
Murine Full-thickness Skin Transplantation
Published on: January 2, 2017
Calcineurin inhibitor conversion to rapamycin can improve graft function in living donor kidney transplantation with
1Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Background:
Recipients of living donor kidney transplantations from older donors often experience a lower glomerular filtration rate (GFR) than those from young donors. Calcineurin inhibitors (CNI) may cause nephrotoxicity, especially in recipients of older donor organs. The aim of this study was to investigate whether CNI withdrawal and conversion to rapamycin improved graft function among transplantation recipients of living donor kidneys from older donors.
Methods:
We collected 83 living donor kidney transplantations using donors aged >50 years from January 2004 to December 2009, including 25 who underwent conversion to rapamycin at the end of 3 months, while 58 cases were maintained on CNI. Baseline characteristics, complications, and graft functions were compared between the groups.
Results:
Donor age, recipient age, body weight, human leukocyte antigen mismatch, delayed graft function, acute rejection rate, serum creatinine, and estimated GFR were comparable between the 2 groups at the end of 3 months. The 1-year serum creatinine were 111.8 ± 25.5 μmol/L in CNI withdrawal versus 132.5 ± 35.9 μmol/L in the CNI-maintained group (P = .013) with 1-year estimated GFR of 86.9 ± 8.2 mL/min versus 77.4 ± 7.2 mL/min and 3-year estimated GFR of 76.1 ± 7.8 mL/min versus 67.0 ± 6.4 mL/min, respectively (both P < .001). The rates of acute rejection were 24% versus 22.4%, and chronic rejection, 4.0% versus 10.3% respectively (P > .05). One CNI withdrawal patient (4.0%) lost the graft function while 4 (6.9%) did so in the CNI-maintained group (P > .05). Logistic multivariate regression showed that maintained CNI usage, acute rejection episodes, and female donors to male recipients were independent risk factors for abnormal 1-year serum creatinine levels (P < .05).
Conclusion:
CNI withdrawal with conversion to rapamycin improved graft function in living donor kidney transplantations from older donors.
Insights
Switching from calcineurin inhibitors (CNI) to rapamycin after kidney transplant from older donors improved kidney function. This CNI withdrawal strategy enhanced estimated glomerular filtration rate (eGFR) at 1 and 3 years post-transplant.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pharmacology
Background:
- Kidney transplant recipients from older living donors often have reduced kidney function (GFR).
- Calcineurin inhibitors (CNI) can cause nephrotoxicity, particularly in older donor organs.
- Investigating alternatives to CNI is crucial for improving outcomes in this patient group.
Purpose of the Study:
- To evaluate the efficacy of calcineurin inhibitor (CNI) withdrawal and conversion to rapamycin.
- To assess the impact on graft function in kidney transplant recipients receiving organs from older living donors.
Main Methods:
- A retrospective study of 83 kidney transplantations from donors aged over 50 years.
- Comparison between 25 patients converted to rapamycin and 58 maintained on CNI at 3 months post-transplant.
- Analysis of baseline characteristics, complications, and graft function (serum creatinine, eGFR).
Main Results:
- No significant differences in baseline characteristics or acute rejection rates between groups.
- CNI withdrawal group showed significantly higher 1-year (86.9 vs 77.4 mL/min) and 3-year (76.1 vs 67.0 mL/min) estimated GFR (P < .001).
- Maintained CNI use was an independent risk factor for abnormal 1-year serum creatinine levels.
Conclusions:
- CNI withdrawal with rapamycin conversion improved kidney graft function in recipients of older donor kidneys.
- This strategy offers a potential benefit for optimizing long-term outcomes in specific kidney transplant populations.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration