Early Sirolimus Conversion as Rescue Therapy in Kidneys With Prolonged Delayed Graft Function in Deceased Donor Renal...

Area of Science:

• Nephrology
• Transplantation immunology
• Pharmacology

Background:

• Donation after circulatory death (DCD) and extended criteria donor (ECD) kidneys are associated with increased delayed graft function (DGF).
• Calcineurin inhibitors (CNIs) can cause nephrotoxicity, potentially leading to primary non-function (PNF).

Purpose of the Study:

• To evaluate the impact of early sirolimus (SRL) conversion on salvaging renal graft function in patients with prolonged DGF.
• To compare outcomes between patients converted to SRL and those maintained on CNIs.

Main Methods:

• Retrospective study comparing a sirolimus (SRL) group (14 patients) with a calcineurin inhibitor (CNI) control group (28 patients).
• Case-matching based on donor and recipient characteristics was performed.
• Analysis of delayed graft function duration and estimated glomerular filtration rate (eGFR) post-transplantation.

Main Results:

• The SRL group experienced longer DGF (42.3 days) compared to the CNI group (26.5 days).
• Mean eGFR in the SRL group improved from 12.2 pre-conversion to 26.0, 34.1, and 28.6 at 3, 12, and 24 months post-conversion.
• Seven patients in the SRL group achieved sustained good graft function.

Conclusions:

• Early conversion to sirolimus (SRL) may salvage renal graft function in patients with prolonged DGF.
• This strategy can potentially lead to long-term graft survival in cases unresponsive to conventional treatments.
• A prospective study is recommended to validate these findings.