Abstract
Conversion from calcineurin inhibitor (CI)-based maintenance immunosuppression to sirolimus (SRL)-based immunosuppression may be beneficial in selected renal transplant recipients. The purpose of this study was to evaluate the safety and efficacy of a daclizumab (DAC) bridge protocol in patients converted from CI- to SRL-based maintenance immunosuppression. We conducted a retrospective chart review of renal transplant recipients who were converted to SRL at least 2 months post-transplant. The protocol consisted of an abrupt discontinuation of either cyclosporin (CsA) or tacrolimus (TAC), initiation of SRL within 48 h of CI discontinuation, and DAC 2 mg/kg at the time of CI discontinuation and again at 14 d (depending on the SRL serum concentration). The SRL starting dose was based on risk stratification in each patient. Twenty-one renal transplant patients were converted to SRL (11 from TAC, 10 from CsA) between October 2001 and July 2003. Conversion occurred at a mean of 23 months post-transplant. Indications for SRL conversion included 12 for chronic allograft nephropathy (CAN), four for CI-associated neurotoxicity, two for thrombotic microangiopathy (TMA), two for post-transplant diabetes mellitus (PTDM), and one for polyoma...Continue Reading
References
May 8, 1986·The New England Journal of Medicine·UNKNOWN Canadian Multicentre Transplant Study Group
Aug 15, 1997·Transplantation·A D MayerE Pohanka
Sep 1, 1999·Kidney International·L C Paul
Feb 17, 2000·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·A M de MattosW M Bennett
Sep 27, 2000·Journal of the American Society of Nephrology : JASN·Bertram L KasiskeJennie Z Ma
Oct 29, 2000·Transplant International : Official Journal of the European Society for Organ Transplantation·W O Bechstein
Feb 22, 2001·Journal of the American Society of Nephrology : JASN·Elly M VAN DuijnhovenJohannes P VAN Hooff
Mar 22, 2001·Kidney International·M R WeirJ C Fink
Dec 26, 2001·Transplantation Proceedings·F DiekmannK Budde
May 14, 2003·Transplantation Proceedings·M F EgidiA O Gaber
Jun 27, 2003·Transplantation Proceedings·F CitterloM Castagneto
Citations
Jan 12, 2007·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·M Colleen HastingsLillian W Gaber
Sep 24, 2009·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Josef FangmannUNKNOWN DACH Study Group
Nov 15, 2006·Transplantation·Atul V MulayGreg A Knoll
Sep 29, 2011·Current Opinion in Nephrology and Hypertension·Beatriz Domínguez-GilJose M Morales
Aug 10, 2010·Transplantation Proceedings·V A KirchnerR Kandaswamy
May 26, 2007·Transplantation Proceedings·N MohsinA Daar
Nov 20, 2008·Pediatric Transplantation·Abanti ChaudhuriMinnie M Sarwal
Feb 20, 2008·Pediatric Transplantation·Leonard C HymesLarry A Greenbaum
Jun 20, 2008·Pediatric Transplantation·Lauren WeintraubMinnie Sarwal
Feb 23, 2011·Pediatric Transplantation·Leonard C Hymes, Barry L Warshaw
Sep 13, 2011·Clinical Transplantation·Bobby Chacko
Mar 1, 2006·Transplantation Proceedings·W Lisik, B D Kahan
Dec 9, 2008·Current Opinion in Organ Transplantation·Ravinder K Wali, Matthew R Weir
Aug 7, 2009·Oral Diseases·R M López-PintorA de Andrés