Effect of sirolimus withdrawal in patients with deteriorating renal function

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Bruce KaplanHerwig-Ulf Meier-Kriesche

Abstract

Sirolimus has been an important addition to immunosuppressive regimens utilized in kidney transplantation. However, sirolimus can potentiate calcineurin inhibitor (CNI) nephrotoxicity by some still uncertain mechanisms. Studies have demonstrated that withdrawal of a CNI under sirolimus immunosuppression can improve renal function. However, it has yet to be demonstrated that withdrawal of sirolimus from such a regimen can also improve renal function and reverse progressive functional deterioration. We studied 17 patients who developed deterioration of renal function while on a CNI and sirolimus. Once an established deterioration in renal function was noted, sirolimus was withdrawn from the regimen and replaced with mycophenolate mofetil. Out of 17 patients with a negative slope in 1/cr, 15 demonstrated a positive treatment effect (change to a positive slope). On aggregate, renal function improved by 18% (creatinine 2.75-2.24 mg/dL), LDL cholesterol improved, as did hematocrit values after withdrawal. The majority of patients on a CNI and sirolimus regimen who experience deterioration in renal function demonstrate improvement in renal function after withdrawal of sirolimus. This strategy may be particularly useful in those patien...Continue Reading

References

Dec 1, 1983·Annals of Internal Medicine·W M Bennett, J P Pulliam
Jul 14, 2001·Clinical Pharmacology and Therapeutics·B D Kahan, W G Kramer
Jul 19, 2002·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·José M MoralesUNKNOWN Sirolimus European Renal Transplant Study Group
Dec 20, 2002·Transplantation·Thomas A GonwaUNKNOWN Sirolimus Renal Function Study Group
Dec 12, 2003·The New England Journal of Medicine·Brian J NankivellJeremy R Chapman
Feb 24, 2004·Journal of the American Society of Nephrology : JASN·Henri KreisUNKNOWN Rapamune Maintenance Regimen Trial

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Citations

Dec 16, 2005·Nephrology·Vincent Ws Lee, Jeremy R Chapman
Mar 20, 2008·Clinical Journal of the American Society of Nephrology : CJASN·Anthony M Jevnikar, Roslyn B Mannon
Mar 20, 2008·Clinical Journal of the American Society of Nephrology : CJASN·Titte R Srinivas, Herwig-Ulf Meier-Kriesche
Jan 28, 2012·Clinical Journal of the American Society of Nephrology : CJASN·Darshika ChhabraLorenzo Gallon
Jun 17, 2014·Seminars in Pediatric Surgery·Michael McCall, A M James Shapiro
Jan 31, 2007·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Monique E ChoJeffrey B Kopp
Mar 29, 2006·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Robert S Gaston
Mar 29, 2006·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Bruce Kaplan
Jul 6, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Tatiana FroudRodolfo Alejandro
Oct 14, 2005·Transplant International : Official Journal of the European Society for Organ Transplantation·Axel AndresThierry Berney
Aug 13, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Herwig-Ulf Meier-KriescheBruce Kaplan
Jul 11, 2006·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·L GallonD Kaufman
Jun 15, 2006·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·S FengB Kaplan
Jul 25, 2007·Transplant International : Official Journal of the European Society for Organ Transplantation·Giselle GuerraHerwig-Ulf Meier-Kriesche
Aug 21, 2008·Transplant International : Official Journal of the European Society for Organ Transplantation·Thierry Berney, Antonio Secchi
Mar 8, 2016·Journal of Biomolecular Screening·Giorgio Gentile, Giuseppe Remuzzi
Aug 11, 2019·Clinical Transplantation·Marina Pontelo CristelliHelio Tedesco-Silva Junior
Mar 17, 2011·Expert Review of Molecular Diagnostics·Valeria R MasDaniel G Maluf

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