Conversion to sirolimus-based immunosuppression in maintenance liver transplantation patients.

Abstract

Sirolimus (SRL) has been proposed to replace calcineurin inhibitors (CNI) in case of CNI-induced toxicity. The aim of this study was to evaluate the efficacy and safety of conversion from CNI to SRL in maintenance liver transplantation (LT) patients. Between 2002 and 2006, conversion was performed in 48 patients (17 female, 31 male; mean age 57 +/- 10 yr) after a median delay of 19.4 months (range 0.2-173 months) after LT. Indication for conversion was renal impairment (RI) (78%), CNI neurotoxicity (13%), or post-LT cancer (9%). Median follow-up was 22.6 +/- 11 months. Median SRL dosage and trough levels were 2.4 +/- 1.3 mg and 8.1 +/- 2.7 microg/L. Immunosuppression consisted of SRL alone (33%), or SRL + mycophenolate mofetil (MMF) (39%), SRL + prednisone (15%), SRL + CNI (4%), or SRL + MMF + prednisone (8%). Mean glomerular filtration rate (GFR) improved from 33 to 48 mL/minute in patients with severe RI (P = 0.022) and from 56 to 74 mL/minute in patients with moderate RI (P = 0.0001). After conversion, main complications were albuminuria (36%), hyperlipidemia (49%), dermatitis (14%), edema (14%), oral ulcers (12%), joint pain (4%), infection (2%), and pneumonia (2%). Acute rejection (AR) occurred in 17% of the patients. SRL was withdrawn in 17% of the patients. In conclusion, conversion from CNI to SRL is safe and is associated with significant renal function improvement.

• Authors: Isabelle Morard, Jérôme Dumortier, Laurent Spahr, Antoine Hadengue, Pietro Majno, Philippe Morel, Gilles Mentha, Emiliano Giostra
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 13 Issue 5 Pg. 658-64 (May 2007) ISSN: 1527-6465 [Print] United States
• PMID: 17457887 (Publication Type: Journal Article)

Chemical References

• Calcineurin Inhibitors
• Immunosuppressive Agents
• Sirolimus

Topics

• Aged
• Calcineurin Inhibitors
• Feasibility Studies
• Female
• Follow-Up Studies
• Glomerular Filtration Rate (drug effects)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Kidney (drug effects, physiopathology)
• Liver Transplantation (adverse effects)
• Male
• Middle Aged
• Neoplasms (etiology)
• Nervous System Diseases (chemically induced)
• Postoperative Care
• Retreatment
• Sirolimus (adverse effects, therapeutic use)
• Treatment Outcome