Long-term results after conversion from calcineurin inhibitors to sirolimus in renal transplant patients

Clinical Transplantation
Gustavo Martinez-MierLuis F Budar-Fernandez

Abstract

Calcineurin inhibitors (CNI) toxicity is one of the contributing factors for the development and progression of chronic allograft dysfunction (CAD). Conversion to sirolimus (SRL) from CNI improves renal function kidney in transplant recipients. A retrospective review from patients abruptly converted from CNI to SRL over a three yr period is reported. Thirty-nine patients were converted 55.2±58 months after renal transplantation. 24 month patient and graft survival was 100% and 92%. Acute rejection incidence was 7.6%. Overall, serum creatinine (SCr) and Cockcroft-Gault creatinine clearance (CGCrCl) improved. In responders, SCr improved from 2.48±0.8 to 1.94±0.8 mg/dL (p<0.05) CGCrCl improved from 37.8±17.4 to 51.9±23.8 mL/min at two years. An increase in proteinuria was observed from conversion to month 12 in responders (189.4±512.8 to 488.3±890.6 mg/day, p<0.05) and from conversion to month six in non-responders (1179.4±2001.1 to 2357±4172.9 mg/day, p<0.05). Low proteinuria had positive predictive value for renal response after conversion. Conversion from CNI to SRL with CAD is associated with improved renal function with an increase in proteinuria. Low proteinuria is a possible positive predictive factor for successful convers...Continue Reading

References

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Citations

Mar 13, 2014·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·A I SutherlandP J Friend

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