Conversion from calcineurin inhibitor to sirolimus in pediatric chronic allograft nephropathy.

摘要: Chronic allograft nephropathy is a major cause for loss in renal transplantation. Sirolimus was recently introduced as potent non-nephrotoxic alternative to calcineurin inhibitors. In the present study, effects of conversion protocol were investigated pediatric chronic with declining glomerular filtration rate (GFR), defined by Schwartz formula clearance below 60 mL/1.73 m(2)/min, steadily increasing serum creatinine and biopsy. eight children median age 12.8 yr, sirolimus started at 32 months after transplantation loading dose 0.24 mg/kg bodyweight (BW), followed 0.2 mg/kgBW/day, aimed trough levels 15-20 ng/mL. Calcineurin inhibitors reduced 50% start discontinued 7 days when target reached. Following conversion, changes GFR significantly stabilized (-2.9 vs. +0.4 mL/min/1.73 m(2)/month, p = 0.025). Individual increased five out patients (p 0.026), only one child exhibited unaltered progression graft failure. responders, mean improved 0.3 mg/dL 0.043). Effects not dependent on or time post-transplantation. Blood pressure, hematological parameters proteinuria remained stable during observation period, lipids transiently. About half suffered from infectious complications. No had be taken off sirolimus; there no period. conclusion, an effective tolerable side stabilize function least yr majority biopsy-proven nephropathy.