Long-Term Outcomes Following Sirolimus Conversion after Renal Transplantation

Long-term outcomes following renal transplantation remain limited due to chronic progressive injury partly as a result of calcineurin inhibitor (CNI) toxicity. Thus, patients have been converted to non-CNI immunosuppressives despite the lack of evidence of long-term benefits from CNI free therapy. W...

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Bibliographic Details
Published in:Immunological investigations 2014-11, Vol.43 (8), p.819-828
Main Authors: Soliman, Karim, Mogadam, Emad, Laftavi, Mark, Patel, Sunil, Feng, Lin, Said, Meriem, Pankewycz, Oleh
Format: Article
Language:English
Subjects:
Adult
Calcineurin avoidance
Calcineurin Inhibitors - therapeutic use
Cost-Benefit Analysis
Drug Substitution - statistics & numerical data
Female
Graft Rejection - drug therapy
Graft Rejection - epidemiology
Graft Rejection - mortality
Graft Survival
Humans
immunosuppressive therapy
Kidney Transplantation
long-term outcomes
Male
Middle Aged
Outcome Assessment (Health Care)
Retrospective Studies
Sirolimus - therapeutic use
Survival Analysis
Time Factors
Treatment Outcome
United States
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Summary:Long-term outcomes following renal transplantation remain limited due to chronic progressive injury partly as a result of calcineurin inhibitor (CNI) toxicity. Thus, patients have been converted to non-CNI immunosuppressives despite the lack of evidence of long-term benefits from CNI free therapy. We now report our 10-year experience converting patients with well functioning transplants from CNI to sirolimus. We retrospectively analyzed outcomes of patients receiving continuous CNI based therapy (CNI, n = 309) or who were switched to sirolimus within the first year of post-transplantation (CONV, n = 54). The groups were similar for most recipient, graft and donor characteristics, however, diabetes was more common in the CNI group and statin use was more frequent in the CONV group. The average time to conversion was 7.2 months and the creatinine level at the time of switching was 1.4 mg/dl. Ten year graft and patient survival rates were equivalent in both groups. There were no differences in the causes of death or graft loss in both groups. Renal function was available for 5 years posttransplant and was no different between groups. Thus, there is no evidence that routinely switching patients with well functioning renal allografts to sirolimus from CNI based immunosuppression provides long-term benefit.
ISSN:0882-0139
1532-4311
DOI:10.3109/08820139.2014.947033