Journal Article

Conversion to sirolimus for chronic renal allograft dysfunction: risk factors for graft loss and severe side effects

Daniel Abramowicz, Karine Hadaya, Marc Hazzan, Nilufer Broeders, Anh-Dung Hoang, Lidia Ghisdal, Christian Noel and Karl Martin Wissing

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 23, issue 11, pages 3727-3729
Published in print November 2008 | ISSN: 0931-0509
Published online June 2008 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfn332

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We retrospectively reviewed our experience with 45 kidney transplant recipients (KTR) that were switched from CNI to SRL, mainly for chronic allograft dysfunction (CAD) (41/45). The mean serum creatinine at switch was 2.5 ± 0.8 mg/dl. At 1 year, patient survival was 93%. Death-censored graft survival was 67% at 1 year and 54% at 2 years. SRL was stopped because of severe side effects in 15 patients. Among these, eight patients developed ‘de novo’ high-grade proteinuria. Univariate analysis revealed that (1) a higher SRL level at 1 month was a predictor of SRL withdrawal due to severe side effects (P = 0.006), and (2) predictors of graft failure after SRL conversion were low SRL loading dose (P = 0.03) and a higher creatinine level at conversion (P = 0.003).

In conclusion, the therapeutic index of SRL in patients suffering from CAD is narrow, with high exposure triggering serious adverse events that may mandate SRL discontinuation, while too low exposure may expose patients to under-immunosuppression and graft loss.

Keywords: graft survival; proteinuria; renal transplantation; sirolimus; toxicity

Journal Article.  1496 words.  Illustrated.

Subjects: Nephrology

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