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Volume: 6 Issue: 4 November 2008 - Supplement - 1

FULL TEXT

EARLY SIROLIMUS TREATMENT FOR HIGH RISK RENAL TRANSPLANT RECIPIENTS. IS IT JUSTIFIED?

Conversion of stable renal transplant recipients (RTR) from calcineurin inhibitors (CNI) to sirolimus (SRL) is safe and effective while this step is still under investigation for recent and high risk RTR. Purpose of this study is to study the long-term effect of early SRL treatment on high risk RTR. Forty five subjects started SRL within one month of transplantation (mean 0.5 ± 0.25 months). The main indications for conversion from CNI/mycophenolate mofetil (MMF)/steroid to SRL/MMF/steroid were rejection (biopsy proven or suspected), CNI toxicity and ATN. MMF was given as full dose (2gm daily) while SRL was maintained on low therapeutic levels. Mean age was 40.6 ± 15.6 years (pediatric and geriatric age groups were not excluded). Mean BMI was 30.2 ± 6.5. There were 40% RTR from diseased donors and 51.1% having 4-6 HLA mismatches. Rejection episodes were reported in 31.1% pre-SRL with 11.1% resistance to steroid treatment. Subsequent rejection episodes were reported in 22.2% with 7.6% resistance to steroid treatment. Mean follow up period after starting SRL was 44.3 ± 8.1 months. Protienuria >2gm/day, leucopenia, anemia, hyper­lipidemia and transaminases increased significantly after SRL (p 0.001, <0.0001, <0.0001, <0.0001 and 0.02 respectively). The patient and graft survival were 88.8% and 93.3% respectively. There were significant improvement in serum creatinine and calculated creatinine clearance by the end of the study (p < 0.0001). High incidence of side effects and infections related to SRL/MMF/steroid combination were reported. SRL was discontinued in 31% for multiple reasons. In conclusion, SRL/MMF/St may be an effective combination as a CNI free immunosuppression regimen for early high risk RTR. During long-term follow up, obesity and higher exposure of MMF resulted in high incidence of SRL/MMF side effects and high rate of SRL treatment discontinuation



Volume : 6
Issue : 4
Pages : 218


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Hamed Alessa Organ Transplantation Center, Ibn Sina hospital, Kuwait, Kuwait