Conversion to Sirolimus in Renal Transplant Recipients: A Single‐Center Experience

Abstract

Maintenance immunosuppression with calcineurin inhibitors (CNI) following renal transplantation is associated with nephrotoxicity and accelerated graft loss. Sirolimus (SRL) is a nonnephrotoxic immunosuppressive agent. We retrospectively analyzed our experience with kidney transplant recipients who were converted from CNI to SRL. A total of 58 renal transplant recipients were converted from CNI to SRL. SRL was started at a dose of 0.075 mg/kg and, at the same time, CNI dose was reduced by 50% daily for 3 days. SRL trough levels were targeted between 8 and 12 ng/mL. When target trough levels were achieved, CNI was withdrawn. The main indications for switching were posttransplant malignancies (n = 32) and chronic allograft nephropathy (CAN) (n = 10). The mean time from transplantation to conversion was 84 +/- 71 months. Mean serum creatinine level was 1.63 +/- 0.52 mg/dL before conversion. Serum creatinine levels at the 1, 3, 6 months, and 1, 2, 3 years after conversion were 1.64 +/- 0.58 mg/dL (P = 0.67), 1.52 +/- 0.53 mg/dL (P = 0.414), 1.62 +/- 0.62 mg/dL (P = 0.734), and 1.48 +/- 0.58 mg/dL (P = 0.065), 1.58 +/- 0.53 mg/dL (P = 0.854), 1.88 +/- 0.77 mg/dL (P = 0.083), respectively. Daily proteinuria levels increased from 0.04 +/- 0.11 g/day at baseline to 0.55 +/- 1.33 g/day (P = 0.037) after conversion, in the responders group. In the nonresponders group, baseline proteinuria was 0.13 +/- 0.25 g/day, and increased to 1.44 +/- 2.44 g/day after conversion (P = 0.008). SRL was discontinued in 16 patients (31%) because of the occurrence of severe side effects. The proportion of patients remaining on SRL therapy over time was 43.1% at 1 year, 15.5% at 2 years after conversion, and 10.3% at 3 years after conversion. SRL conversion may be very useful in patients suffering from neoplasia; however, frequent side effects related with this intervention should be considered, and routine conversion from CNI to SRL to reduce nephrotoxicity should be discouraged.

The Impact of BK Virus and Cytomegalovirus Infections on Graft in Renal Transplant Patients: Experience of a Tertiary Hospital in Turkey

“…In a study by Rota et al [16] investigating the BK and JC virus DNA positivity in the clinical samples of patients with high risk, one blood sample was found to be BKV DNA positive (1/62; 1.6%). In a study by Yelken et al [15] investigating BKVAN in patients with renal transplant, BKVAN was detected in 11 (2.7%) of 412 patients, graft loss developed in two of three patients with acute rejection and kidney functions of other patients returned to baseline values. Almeras et al [17] monitored the BKV DNA values in 119 renal transplant recipients with 6-month intervals, BK viraemia was detected in 13 patients (10.9%); in 11 patients, viraemia became negative with reduction of immunosuppressive dose, one patient had decreased levels and one patient (0.8%) had increased levels and developed graft rejection.…”

“…The incidence of BKVAN is 1-10% in renal transplant patients and leads to graft loss in 40-80% of these patients [15] . In a study by Rota et al [16] investigating the BK and JC virus DNA positivity in the clinical samples of patients with high risk, one blood sample was found to be BKV DNA positive (1/62; 1.6%).…”

BK Nephropathy in Renal Transplant Patients: Review

“…Hastalar, BKVN'den sonra ortalama 19±20 ay takip edilmişler, sekiz hastanın greft fonksiyonları stabil giderken, üç hasta diyalize dönmüştür. 76 Yine karaciğer nakli yapılan 39 hastanın incelendiği bir ça-lışmada, hastaların %12,8'inde viremi, %33,3'ünde decoy hücresi ve %28,2'sinde virüri bulunmuştur. Tedaviye rağmen hastaların %15,3'ünde rejeksiyon gelişmiştir.…”

Artificial Organs 2010: A Year in Review

“…Berna Yelken et al. (133) of Istanbul University, Istanbul, Turkey reported on the use of sirolimus (SRL), a nonnephrotoxic immunosuppressive agent, in renal transplant recipients as compared with the use of calcineurin inhibitors (CNIs). SRL conversion may be very useful in patients suffering from neoplasia; however, frequent side effects related with this intervention should be considered, and routine conversion from CNI to SRL to reduce nephrotoxicity should be discouraged.…”