Five-Year Follow-up After Late Conversion From Calcineurin Inhibitors to Sirolimus in Patients With Chronic Renal Allograft Dysfunction

DOI to cite this document:

10.5283/epub.1975 Copy

Krüger, Bernd ; Fischereder, Michael ; Jauch, Karl W. ; Graeb, Christian ; Hoffmann, Ute ; Böger, Carsten A. ; Banas, Bernhard ; Obed, Aiman ; Schlitt, Hans-Jürgen ; Krämer, Bernhard K.

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Date of publication of this fulltext: 05 Aug 2009 13:35

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Details

Item type:	Article
Journal or Publication Title:	Transplantation proceedings
Volume:	39
Number of Issue or Book Chapter:	2
Page Range:	pp. 518-521
Date:	March 2007
Institutions:	Medicine > Lehrstuhl für Innere Medizin II
Identification Number:	Value Type 10.1016/j.transproceed.2006.12.004 DOI 17362772 PubMed ID
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	1975

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Abstract

BACKGROUND: Chronic allograft nephropathy (CAN) is, among others, caused by nephrotoxic side effects of calcineurin inhibitors (CNI), which are to date still the mainstay of immunosuppressive therapy. Sirolimus (SIR), an immunosuppressive compound without effects on glomerular perfusion, has been used in CNI-sparing immunosuppressive protocols. We report the 5-year follow-up of a prospective, ...

Abstract

BACKGROUND: Chronic allograft nephropathy (CAN) is, among others, caused by nephrotoxic side effects of calcineurin inhibitors (CNI), which are to date still the mainstay of immunosuppressive therapy. Sirolimus (SIR), an immunosuppressive compound without effects on glomerular perfusion, has been used in CNI-sparing immunosuppressive protocols. We report the 5-year follow-up of a prospective, controlled conversion study from CNI to SIR in patients with moderately to severely impaired renal function. METHODS: Twelve renal transplant recipients with moderately to severely impaired renal function (estimated glomerular filtration rate of 17 to 35 mL/min according to the MDRD formula), enrolled in a prospective, controlled 1-year pilot study were followed for 5 years. RESULTS: Three renal grafts (25%) were lost during the 5-year follow-up. Graft loss was due to noncompliance in one patient and to CAN in the other two patients. These two patients returned to dialysis 43 and 59 months after conversion, corresponding to 86 and 75 months after transplantation, respectively. Six of nine patients had a stable or even better renal function compared to the baseline. The lipid profile increased initially, but then remained stable over time. CONCLUSION: Conversion of immunosuppressive therapy from CNI to SIR in patients with impaired renal function more than 1 year after transplantation is feasible and safe yielding improved renal function in the majority of patients, which was sustained at 5 years follow-up.

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