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Updated: Feb 9, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Effect of Sirolimus on Native Total Kidney Volume After Transplantation in Patients with Autosomal Dominant
1Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado.
Background:
The mammalian target of rapamycin (mTOR) pathway has been shown to be central to cyst formation and growth in patients with autosomal dominant polycystic kidney disease (ADPKD). Drugs that suppress mTOR signaling are frequently used as antiproliferative agents for maintenance immunosuppression in patients who have undergone kidney transplantation. The aim of this study was to determine the effect of sirolimus, an mTOR inhibitor, on cyst volume regression in patients with ADPKD who have undergone renal transplantation.
Methods:
In this single-center, prospective, open-label, parallel-group, randomized trial, 23 adult patients with ADPKD who successfully underwent renal transplantation from 2008 to 2012 were subsequently randomized (on a 1:1 basis) to a maintenance immunosuppression regimen with either sirolimus (sirolimus, tacrolimus, prednisone) or mycophenolate (mycophenolate, tacrolimus, prednisone). Total kidney volumes were measured by means of high-resolution magnetic resonance imaging within 2 weeks after transplantation and at 1 year. The primary end point was change in total kidney volume at 1 year.
Results:
Sixteen patients completed the 1-year study (8 patients in each group). There was a decrease in kidney volume in both the sirolimus group (percentage change from baseline, 20.5%; P < .001) and mycophenolate group (percentage change from baseline, 17%; P = .048), but there was no significant difference in percentage change of total kidney volume between the groups (P = .665).
Conclusions:
In ADPKD patients at 1 year after kidney transplantation, there was a similar decrease in polycystic kidney volume in patients receiving an immunosuppression regimen containing sirolimus compared with patients receiving mycophenolate.
Insights
Sirolimus, an mTOR inhibitor, and mycophenolate both reduced kidney cyst volume in kidney transplant patients with autosomal dominant polycystic kidney disease (ADPKD). The study found similar volume reductions between the two immunosuppression regimens after one year.
Area of Science:
- Nephrology
- Immunology
- Pharmacology
Background:
- The mammalian target of rapamycin (mTOR) pathway is crucial for cyst development in autosomal dominant polycystic kidney disease (ADPKD).
- mTOR inhibitors like sirolimus are used for immunosuppression post-kidney transplantation.
- This study investigates sirolimus's effect on cyst regression in kidney transplant recipients with ADPKD.
Purpose of the Study:
- To evaluate the efficacy of sirolimus, an mTOR inhibitor, in reducing kidney cyst volume in ADPKD patients post-renal transplantation.
- To compare the effects of sirolimus-based versus mycophenolate-based immunosuppression on polycystic kidney volume.
Main Methods:
- A single-center, prospective, randomized trial involving 23 adult ADPKD patients post-renal transplantation.
- Patients were randomized to receive either sirolimus or mycophenolate as part of their maintenance immunosuppression.
- Total kidney volumes were measured using MRI at baseline and 1 year post-transplantation.
Main Results:
- Both sirolimus and mycophenolate groups showed a significant decrease in total kidney volume after one year (20.5% and 17%, respectively).
- No statistically significant difference was observed in the percentage change of total kidney volume between the sirolimus and mycophenolate groups (P = 0.665).
Conclusions:
- Sirolimus-based immunosuppression achieved a comparable reduction in polycystic kidney volume to mycophenolate-based immunosuppression in ADPKD patients one year after kidney transplantation.
- These findings suggest that mTOR inhibitors can be effective in managing cyst burden in this patient population.
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