Experience With the Use of Sirolimus in Liver Transplantation—Use in Patients for Whom Calcineurin Inhibitors Are Contraindicated

摘要: Sirolimus (SRL) provides effective immunosuppression for kidney transplantation and may be useful in patients with delayed allograft function after transplantation. We review our experience SRL liver transplant recipients whom calcineurin inhibitors are undesirable. Fourteen renal insufficiency or acute mental status impairment were administered (5- to 10-mg load, 1 4 mg/d). Immunosuppression also consisted of mycophenolate mofetil corticosteroids. On resolution neurological dysfunction (return baseline serum creatinine level), tacrolimus (TAC) therapy was initiated. Twelve received primary transplants, patient a combined liver-kidney transplant, third transplant. Follow-up 2 7 months. Calcineurin initially withheld 9 patients, aborted because toxicity the remaining 5 patients. Mean times initiation TAC 5.4 +/- 4.6 26.8 24.4 days, respectively. Serum trough levels did not correlate dose other variables. Two died prolonged pretransplantation hospital courses intensive care unit. Six experienced rejection, but only required antilymphocyte therapy. at start 2.2 1.1 1.2 0.6 mg/dL 3 All indications had return their status. improved chemistry test results prothrombin times. No developed leukopenia thrombocytopenia. is safe impairment. an attractive alternative when undesirable, should monitored. A prospective randomized study SRL-based inhibitor-avoiding regimen compared standard will further evaluate role