Conversion of stable renal transplant recipients (RTR) from calcineurin inhibitor (CNI) to sirolimus (Sir) is safe and effective. To study the effect of early and late conversion of high risk RTR maintained on CNI, mycophenolate mofetil (MMF) and steroid (St) to Sir, MMF and St regimen on the graft and patient outcome.
Materials and methods: The first 100 subjects converted to Sir in our center were prospectively observed. The main reasons for conversion were rejection, CNI toxicity CNI elimination and ATN. Mean follow up period was 45.3 months. Forty five subjects started Sir within one month of transplantation (mean 0.5 months) (group A). Fifty five subjects started Sir later (mean 21.9 months) (group B). Protienuria >2gm/day, leucopenia and hyperlipidemia increased significantly after conversion. There was significant improvement in serum creatinine and creatinine clearance (p0.0001). The patient and graft outcome was 95% and 90% respectively. There were higher incidence of oedema and lymphocele in group A (p0.0001). There were no other significant differences between both groups in the demographic features or graft and patient outcome. Early and late conversion from CNI to Sir is safe and effective in high risk RTR during long-term follow up.