Mammalian targets of
rapamycin inhibitors (mTORIs), including
sirolimus and
everolimus, are used for minimizing
calcineurin inhibitors after
liver transplantation. However, head-to-head randomized comparisons of these 2 mTORIs are lacking. We assessed the differences in renoprotection and possible mechanisms between
sirolimus and
everolimus in
liver transplant recipients. For this prospective cohort study, we recruited
liver transplant recipients whose regimens were switched from
tacrolimus to
sirolimus or
everolimus at a Taiwan medical center. Serial changes in estimated glomerular filtration rate (eGFR), urinary N-acetyl-β-D-
glucosaminidase,
neutrophil gelatinase-associated lipocalin,
8-hydroxy-2'-deoxyguanosine, and transforming growth factor-β1 during 1 year after mTORI conversion were compared within and between groups. In the 61 patients analyzed, no significant change in eGFR occurred within 12 months after conversion in both mTORI groups. Among patients with baseline eGFR <60 mL/min/1.73 m2 , eGFR improved at 6 months and 1 year after conversion (+12.3 and +12.0 mL/min/1.73 m2 , both P < .05). Urinary N-acetyl-β-D-
glucosaminidase decreased in both
sirolimus and
everolimus groups at 6 months (-68.7 ± 137.6 and -62.0 ± 92.4 U/g
creatinine, both P < .05), and the reduction of urinary
neutrophil gelatinase-associated lipocalin was significant in the
sirolimus group (-4345.1 ± 7763.5 ng/g
creatinine; P < .05). Neither transforming growth factor-β1 nor 8-hydroxy-2´-deoxyguanosine changed significantly. In conclusion, the renoprotective effect of mTORI conversion was significant in
liver transplant recipients with
renal insufficiency, which was similar for
sirolimus and
everolimus, in the first year and may be associated with ameliorated tubular injury. Available evidence remains insufficient to determine which mTORI conversion
therapy is more effective in renoprotection in the long run.