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 OJOTS  Vol.1 No.1 , August 2011
Conversion from Calcineurin Inhibitors to Sirolimus Maintenance Therapy in Renal Allograft Recipients with Risk Factors
Abstract: Background: The efficacy and safety of conversion treatment with sirolimus in renal transplant recipients using the calcineurin inhibitor (CNI) with one or more risk factors was evaluated. Methods: Ninety-three renal transplant recipients were prospectively enrolled. CNIs(CsA and FK506) as main immunosuppressant were converted to SRL immunosuppressant protocol. Rapid conversion with si-rolimus was performed in all patients. The CNI withdrawal was in 2 weeks. At 4 hours after oral administration of cyclosporin A or tacrolimus, the patients took sirolimus. Initial dose of sirolimus was 6 mg, and repeated maintenance dose is 1.0 - 2.0 mg/d. The first concentration of sirolimus was detected at 5 - 7 days after first oral administration, and the target concentration was 6 - 10 μg/L. Results: The symptoms were markedly improved in patients with CNI induced renal toxicity and CNI induced liver toxicity, and the concentration of sirolimus were maintained at (5.1 ± 1.2) μg/L. Serum creatinine levels decreased from (297.72 ± 150.28) μmol/L to (123.76 ± 44.2) μmol/L, and the liver function were recovery in 24 (92.3%) patients. 9 patients with high glucose returned to normal, and 2 patients were improved. Serum creatinine levels decreased more than 25% of primary level in 17 patients, and the effective rate was 51.5%. 10 patients with tumor were appeared 6 - 43 months after renal transplantation, no recurrence was found in 8 of them and 2 patients were dead. Acute rejections were occurred in 3 patients at 6 months after conversion treatment. The complications were included hyperlipidemia and proteinuria. 3 patients were dead, 6 patients returned to dialysis treatment, and 2 patients were removal of grafts. At 3 years after conversion treatment, the survival rates of patients and grafts were 90.9% and 75.8%, respectively. Conclusion: The conversion treatment with SRL and MMF may be a better option for the renal transplant recipients using the CNI with risk factors appeared.
Cite this paper: nullJi, S. , Wen, J. , Cheng, D. , Sun, Q. , Chen, J. and Liu, Z. (2011) Conversion from Calcineurin Inhibitors to Sirolimus Maintenance Therapy in Renal Allograft Recipients with Risk Factors. Open Journal of Organ Transplant Surgery, 1, 8-13. doi: 10.4236/ojots.2011.11002.
References

[1]   L. Li and Q. Sun, “Renal transplantation in China: Ten Years of Experience at Nanjing Jinling Hospital,” Clinical Transplants, Vol. 1, No. 5, 2006, pp. 71-77.

[2]   A. Magnasco, A. Rossi, P. Catarsi, R. Gusmano, F. Ginevri, F. Perfumo and G. M. Ghiggeri, “Cyclosporin and Organ Specific Toxicity: Clinical Aspects, Pharmacogenetics and Perspectives,” Current Clinical Pharmacology, Vol. 3, No. 3, 2008, pp. 166-173. doi:10.2174/157488408785747674

[3]   D. W. Hanto and R. Chudzinski, “What Does the CONVERT Trial Really Tell Us about Conversion from Calcineurin Inhibitors to Sirolimus?” Transplantation, Vol. 87, No. 2, 2009, pp. 164-165. doi:10.1097/TP.0b013e318192790f

[4]   J. R. Chapman, “Chronic Calcineurin Inhibitor Nephrotoxicity-Lest We Forget,” American Journal of Trans-plantation, Vol. 11, No. 4, 2011, pp. 693-697. doi:10.1111/j.1600-6143.2011.03504.x

[5]   R. Pfitzmann, J. Klupp, J. M. Langrehr, M. Uhl, R. Neuhaus, U. Settmacher, T. Steinmüller and P. Neuhaus, “Mycophenolatemofetil for Immunosuppression after Liver Transplantation: A Follow-up Study of 191 Patients,” Transplantation, Vol. 76, No. 1, 2003, pp. 130-136. doi:10.1097/01.TP.0000071522.74885.48

[6]   D. R. Kuypers, K. Claes, B. Bammens, P. Evenepoel and Y. Vanrenterghem, “Early Clinical Assessment of Glucose Metabolism in Renal Allograft Recipients: Diagnosis and Prediction of Post-Transplant Diabetes Mellitus (PTDM),” Nephrology Dialysis Transplantation, Vol. 23, No. 6, 2008, pp. 2033-2042. doi:10.1093/ndt/gfm875

[7]   K. Solez, R. B. Colvin, L. C. Racusen, B. Sis, P. F. Hal-loran, P. E. Birk, P. M. Campbell, M. Cascalho, A. B. Collins, A. J. Demetris, C. B. Drachenberg and I. W. Gib-son, “Banff 05 Meeting Report: Differential Diagnosis of Chronic Allograft Injury and Elimination of Chronic Allo-graft Nephropathy (‘CAN’),” American Journal of Transplantation, Vol. 7, No. 3, 2007, pp. 518-526. doi:10.1111/j.1600-6143.2006.01688.x

[8]   J. C. Ruiz, A. Alonso, M. Arias, J. M. Campistol, M. G. Molina, J. M. G. Posada, J. M. Grinyo, J. M. Morales, F. Oppenheimer, A. Sánchez Fructuoso and J. Sán-chezPlumed, “Conversion to Sirolimus,” Nefrologia, Vol. 26, No. 2, 2006, pp. 52-63.

[9]   S. M. Ji, L. S. Li, J. Q. Wen, G. Z. Sha, Z. Cheng, D. R. Cheng, J. S. Chen and Z. H. Liu, “Therapeutic effect of Tripterygium Wilfordii Hook f. on Proteinuria Associated with Sirolimus in Renal Transplant Recipients,” Transplant Proceedings, Vol. 40, No. 10, 2008, pp. 3474-3478. doi:10.1016/j.transproceed.2008.07.140

[10]   W. Ji-qiu and J. Shuming, “Alleviation of Calcineuron Inhibitorinduced Nephrotoxicity with Rapamycin,” Chinese Journal of Nephrology Dialysis & Transplantation, Vol. 16, No. 3, 2007, pp. 283-288.

[11]   J. Shu-ming, W. Ji-qiu, S. Guo-zhu, C. Dong-rui, S. Qi-quan, C. Jin-Song, L. Zhi-hong and L. Lei-shi, “Conversion Treatment with Sirolimus in Renal Transplant Recipients,” Journal of Clinical Rehabilitative Tissue Engineering Research, Vol. 13, No. 31, 2009, pp. 6019-6022.

[12]   A. Gürkan, S. Kacar, U Erdogdu, C Varilsüha, G. Kandemir, C. Karaca and F. Akman, “The Effect of Sirolimus in the Development of Chronic Allograft Nephropathy,” Transplant Proceedings, Vol. 40, No. 1, 2008, pp. 114-116. doi:10.1016/j.transproceed.2007.11.005

[13]   S. M. Ji, L. S. Li, G. Z. Sha, J. S. Chen and Z. H. Liu, “Conversion from Cyclosporine to Tacrolimus for Chronic Allograft Nephropathy,” Transplant Proceedings, Vol. 39, No. 5, 2007, pp. 1402-1405. doi:10.1016/j.transproceed.2006.11.030

[14]   J. M. Campistol, J. Albanell, W. Arns, I Boletis, J. Dantal, J. W. de Fijter, S. A. Mortensen and H. H. Neumayer, “Use of Proliferation Signal Inhibitors in the Management of Post-Transplant Malignancies-Clinical Guidance,” Nephrology Dialysis Transplantation, Vol. 22, No. S1, 2007, pp. i36-i41. doi:10.1093/ndt/gfm090

[15]   M. Schubert, RVenkataramanan, D. W. Holt, L. M. Shaw, W. McGhee, J. Reyes, S. Webber and R. Sindhi, “Phar-macokinetics of Sirolimus and Tacrolimus in Pediatric Transplant Patients,” American Journal of Transplantation, Vol. 4, No. 5, 2004, pp. 767-773. doi:10.1111/j.1600-6143.2004.00411.x

[16]   X. Y. Qiu, Z. Jiao, M. Zhang, L. J. Zhong, H. Q. Liang, C. L. Ma, L. Zhang and M. K. Zhong, “Association of MDR1, CYP3A4*18B, and CYP3A5*3 Polymorphisms with Cyclosporine Pharmacokinetics in Chinese Renal Transplant Recipients,” European Journal of Clinical Pharmacology, Vol. 64, No. 11, 2008, pp. 1069-1084. doi:10.1007/s00228-008-0520-8

 
 
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