Conversion to sirolimus in solid organ transplantation: a single-center experience.

摘要: BACKGROUND Calcineurin inhibitors are associated with adverse events, including nephrotoxicity and diabetes that might reduce the benefits of long-term graft survival. We report our experience in converting kidney (K), kidney-pancreas (KP), pancreas (P), (L) recipients from a calcineurin inhibitor/mycophenolate mofetil (MMF)/prednisone dose-induced (K = 9, KP 5, P 1, L 5), hemolytic uremic syndrome (HUS) 7, chronic allograft nephropathy 12, 1), glucose intolerance 6, 2, 2). METHODS The conversion protocol consisted an abrupt discontinuation inhibitor sirolimus (8-12 mg, PO loading dose) initiated 24-72 hours after stopping inhibitor. Sirolimus was titrated to target trough levels 12-16 ng/mL. Daclizumab 2 mg/kg IV given all on days 0 14 postconversion. RESULTS Resolution HUS occurred 12 patients (100%) drop serum creatinine 3.3 +/- 1.5 1.8 0.9 mg/dL (P =.04). due nephrotoxicity, HUS, improved 2.9 1.4 2.2 =.01). Eleven 19 (58%) resolved intolerance. Two suffered rejection noncompliance. Increases cholesterol (208 70 243 77 mg/dL, <.05) triglycerides (232 145 265 148 NS), minimal reduction platelet values (243 85 237 85, NS) occurred. CONCLUSIONS These data suggest inhibitor-free immunosuppressive regimen sirolimus, mycophenolate mofetil, steroids preserves function clinical indications warranting discontinuation.