Long-term results in renal transplant patients with allograft dysfunction after switching from calcineurin inhibitors to sirolimus

摘要: BACKGROUND Switching from calcineurin inhibitors (CNIs) to sirolimus might improve renal function in chronic transplant patients. METHODS In a prospective study, we assessed long-term efficacy and safety parameters 43 recipients who were switched CNI (cyclosporin A, 65%; tacrolimus, 35%) for either allograft dysfunction (n = 38) or recurrent cutaneous cancers 5). A kidney biopsy was done 79% of patients prior conversion, showed nephropathy 26) nephrotoxicity 7). Conversion abrupt progressive, with withdrawal over 3 weeks. All also received steroids without mycophenolate mofetil azathioprin. Patient data recorded at baseline (D0), 1 (D30) 6 months (D180), 1, 1.5 2 years post-conversion. RESULTS After mean post-conversion follow-up 27+/-1.5 months, 58% the still on sirolimus. The survival intent treat grafts 95.3 93%, respectively. Overall, there significant improvement function, creatinine clearance increasing 49.4+/-14.9 53+/-16.3 ml/min D30 (P 0.01), 54.7+/-20 D180 0.01). Thereafter, not different baseline, i.e. 54.7+/-21.7, 52.8+/-20 51.7+/-20.3 2, We divided into two groups: responders 29), those an increase compared D0, non-responders 14), decrease D0. univariate analysis, factors predictive response included proteinuria D0 magnitudes differences between serum lactate dehydrogenase. conversion associated (i) decreases calcium, phosphorus uric acid, haemoglobin levels; (ii) increases alkaline phosphatase, total cholesterol, parathyroid hormone, number statin recombinant erythropoietin therapies; (iii) appearance de novo >1 g/day 28% 12% entire cohort. Kidney biopsies 17 after same Banff scores as observed baseline. identified three independent switch: absence proteinuria, presence antihypertensive therapy dehydrogenase level D30. CONCLUSION CNIs improved function; however, 33% developed overt proteinuria.