Ganji Mohammad Reza, Hakemi Monir Sadat, Esfehani Fatemeh, Alatab Sudabeh, Naderi Gholam Hossein
Department of Nephrology, Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Kidney Dis. 2013 Jul;7(4):309-15.
As an immunosuppressive treatment, cyclosporine carries a significant risk of nephrotoxicity. In this study, we assessed the safety and efficacy of sirolimus conversion in our kidney transplant recipients.
Sirolimus conversion in 99 kidney transplant recipients was evaluated. Serum level of creatinine, glomerular filtration rate (GFR), and the occurrence of adverse effects of sirolimus were evaluated at conversion time and 1, 6, 12, 24, and 36 months after conversion.
The major causes of conversion were chronic allograft nephropathy and cyclosporine nephrotoxicity. The median time to conversion and follow-up were 54.7 months and 24 months, respectively. Three patients died during the study period. The acute rejection rate was 4%. In 16.6% of the patients, sirolimus was discontinued because of refractory adverse effects. No significant changes in estimated GFR and incidence of adverse effects were observed between patients with baseline estimated GFR lower or higher than 40 mL/min. Patients with early sirolimus conversion (less than 6 months after transplant) had improvement of their GFR (59.9 +/- 22.3 mL/min to 68.0 +/- 15.5 mL/min, P = .02), while kidney recipients with late conversion did not show such an improvement. The difference between GFRs in these two groups reached significant level at 12 months and stayed significant until the end of the follow-up.
This study emphasizes that conversion of cyclosporine to sirolimus could be associated with stable kidney allograft function. However, cyclosporine discontinuation should be considered early when it is indicated.
作为一种免疫抑制治疗药物，环孢素具有显著的肾毒性风险。在本研究中，我们评估了肾移植受者转换为西罗莫司治疗的安全性和有效性。
对99例肾移植受者的西罗莫司转换治疗进行了评估。在转换时以及转换后1、6、12、24和36个月，评估血清肌酐水平、肾小球滤过率（GFR）以及西罗莫司不良反应的发生情况。
转换治疗的主要原因是慢性移植肾肾病和环孢素肾毒性。转换治疗的中位时间和随访时间分别为54.7个月和24个月。3例患者在研究期间死亡。急性排斥反应率为4%。16.6%的患者因难治性不良反应停用西罗莫司。基线估计GFR低于或高于40 mL/min的患者之间，估计GFR和不良反应发生率无显著变化。早期转换为西罗莫司的患者（移植后不到6个月）的GFR有所改善（从59.9±22.3 mL/min提高到68.0±15.5 mL/min，P = 0.02），而晚期转换的肾移植受者未显示出这种改善。两组GFR的差异在12个月时达到显著水平，并一直保持到随访结束。
本研究强调，环孢素转换为西罗莫司可能与移植肾的稳定功能相关。然而，在有指征时应尽早考虑停用环孢素。
