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Long-term effects on renal function of dose-reduced calcineurin inhibitor and sirolimus in cardiac transplant patients.

AbstractUNLABELLED:
Calcineurin inhibitor (CNI)-associated renal insufficiency is common after cardiac transplantation (CTX); however, the addition of sirolimus allows for CNI dose reduction and this strategy may limit CNI renal toxicity. This study examines the long-term effects of such a strategy.
METHODS:
Patients from a single center who had CTX from 1990 to 2007 and who were converted to sirolimus and a dose-reduced CNI were compared to group-matched controls maintained on CNI and an antiproliferative agent.
RESULTS:
One hundred and fifty-five patients (79 sirolimus and 76 controls) were included and had similar baseline characteristics. Sirolimus was started a mean of 1429 d post-CTX and maintained for a mean of 823 d. Reason for conversion to sirolimus was renal insufficiency (34%), vasculopathy (29%), recurrent rejection (19%), and other (18%). The eGFR was not different between groups at baseline (44.7 mL/min/1.73 m(2) vs. 46.0, p = 0.64) or at any point during follow-up: 90 d, 180 d, 1 yr, 2 yr, and 3 yr. conclusion: Patients converted to a regimen of sirolimus and a dosed-reduced CNI have stable renal function over the following three yr, but do not have an improvement in renal outcomes compared to patients maintained on full dose CNI.
AuthorsSameer J Khandhar, Hemal V Shah, Michael A Shullo, Rachelle Zomak, Michelle Navoney, Dennis M McNamara, Robert L Kormos, Yoshiya Toyoda, Jeffrey J Teuteberg
JournalClinical transplantation (Clin Transplant) 2012 Jan-Feb Vol. 26 Issue 1 Pg. 42-9 ISSN: 1399-0012 [Electronic] Denmark
PMID21303417 (Publication Type: Comparative Study, Journal Article)
Copyright© 2011 John Wiley & Sons A/S.
Chemical References
  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Sirolimus
Topics
  • Calcineurin Inhibitors
  • Case-Control Studies
  • Female
  • Glomerular Filtration Rate
  • Graft Rejection (prevention & control)
  • Heart Transplantation (adverse effects, immunology)
  • Humans
  • Immunosuppressive Agents (therapeutic use)
  • Kidney Failure, Chronic (drug therapy, etiology)
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Retrospective Studies
  • Sirolimus (therapeutic use)
  • Time

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