Who will benefit from sirolimus based conversion therapy?
- VernacularTitle:哪些患者可以从转换西罗莫司中受益?
- Publication Type:Journal Article
- Keywords: Sirolimus; Immunosuppressive agents; Kidney transplantation
- From: Chinese Journal of Urology 2008;(11):748-751
- CountryChina
- Language:Chinese
- Abstract: Objective To evaluate the safety and efficacy of conversion from Calcineurin inhibi-tor (CNI) based therapy to sirolimus (SRL) based therapy in renal transplantation. Methods One hundred and fifty-seven renal transplant recipients postoperative 3 months were enrolled to A, B, C and D groups according to different reasons. Group A (n= 62) was consisted of the patients of early conversion, group B (n=50) of increased serum creatinine (SCr), group C (n=37) of increased total bilirubin (TB), and group D (n=8) of neoplasms. All the patients withdrew CNI and received SRL based therapy. All the patients were followed up for 6 months to observe the incidences of acute rejec-tion (AR) and adverse events. Results Both the patient and graft survival rates were 100%. Inci-dence of acute rejection was 1.3% (2/157). After the conversion, SCr and uric acid of the 157 patients decreased, meanwhile creatinine clearance rate (CCr) increased. In group A, SCr decreased from 99.04 μmol/L to 91.86 μmol/L(P<0.01), while CCr increased from 70.50 ml/min to 78.27 ml/min. In group B, SCr decreased from 142.96 μmol/L to 128.15 μmol/L, while CCr increasedfrom 47.66 ml/min to 53.38 ml/min. In group C, SCr decreased from 97.09 μmol/L to 88.34 μmol/L,while CCr increased from 69.38 ml/min to 75.66 ml/min. In group D, SCr decreased from 97.46 μmol/L to 88.91 μmol/L, while CCr increased from 62.29 ml/min to 67.64 ml/min. TB and di-rect bilirubin of group C decreased from 30.45, 15.15 μmol/L to 12. 13, 3.70 μmol/L(P<0.01).Common adverse events included fever, hyperlipidemia and proteinuria. Incidence of fever was 7.0% (11/157). Conclusions Early conversion from CNI based therapy to SRL based immunosuppressive therapy is safe and effective in renal transplantation recipients of increased SCr. And the patients with post-transplant neoplasms and CNI-induced hyperbilirubinemia and hyperuricemia can benefit from SRL based conversion therapy.