Study Of Conversion Treatment With Sirolimus In Kidney Transplant Recipients

Objective:We evaluate the efficacy and safety of converting Calcineurin inhibitor (CNI) to Sirolimus (SRL) in kidney transplant recipients with some risk factors related to CNI immunosuppressives.Methods:Sixty eligible kidney transplant recipients treated with CNI as main immunosuppressives were converted to SRL immunos- uppressive protocol with decreasing CNI dose gradually until withdrawal completely (within 2 weeks). SRL was titrated to target trough levels of 4～12ng/ml. All the recipients are follow-up more than 6 months. The clinical outcome, complications and side effects were observed.Results:The mean conversion period was (18.5±13.4) months after transplant and mean follow-up period was (8.5±2.1) months. The actual SRL target trough levels at one week, two weeks, one month, three months and six months were (11.6±4.0)ng/ml, (9.5±3.8) ng/ml, (8.7±4.2)ng/ml, (8.4±3.2)ng/ml and (7.7±3.5)ng/ml respectively. Eight recipients (13.3%) experienced acute rejection; seven recipients (11.1%) were complicated with pulmonary infection within 6 months after SRL conversion. Serum creatinine of 44 case CAN recipients dropped from 144.1±61.7μmol/L (at conversion) to 130.5±35.7μmol/L (1stmonth), 116.6±30.6μmol/L (3rdmonth) and 119.0±24.6μmol/L (6thmonth) respectively. There are significant difference when compare with pre-conversion. SRL conversion protocol improved CNI-related hepatoxicity and hyperglycemia. SRL conversion results in hyperlipemia and protein urine in some recipients.Conclusion:SRL conversion benefits to the improvement of kidney function of CAN recipients, although followed with the risk of acute rejection and systematic infection. SRL conversion also improved CNI-related hepatoxicity and hyperglycemia. However, hyperlipemia and protein urine are main SRL related side effects in this study.