Kidney transplantationImmunosuppressionConversion to Proliferation Signal Inhibitors–Based Immunosuppressive Regimen in Kidney Transplantation: To Whom and When?
Section snippets
Methods
Between December 2007 and May 2010, we converted 62 renal transplant recipients from cyclosporine (CsA) or tacrolimus to sirolimus or everolimus for various reasons. None of the patients experienced an acute rejection episode and/or significant proteinuria (500 mg/dL). All patients received SRL (46) or EVR (16) and prednisone with CNI minimization after conversion. (GFRs) Glomerular filtration rates were calculated by the Cockcroft-Gault method of before initiation of PSI (baseline) and at 6
Results
The mean age of the 62 patients including 19 women and 43 mens at transplantation was 38.0 ± 13.1 years. Fifty-four were transplanted from living related and 8 from cadaveric donors. The donor and recipient demographic features are presented in Table 1.
The reasons for conversion were: BK virus nephropathy (n = 4), skin malignancy (n = 1), 1, chronic allograft nephropathy (n = 18), and older donor age (n = 20). Immunosuppressive therapy was converted to a PSI-based triple regimen at 172.0 ±
Discussion
There is no standard therapy to treat deteriorating renal function among transplant recipients. Multiple strategies have been attempted to slow the progression of allograft dysfunction, including addition of mycophenolate mofetil, reduction of CsA dose, and conversion to sirolimus or everolimus (6–8). Attempts to minimize CNI nephrotoxicity by reducing the dose or withdrawing CNI from immunosuppressive regimens have been limited by acute rejection rates.9, 10 In the present study, only 2/62
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