Clinical effects of sirolimus treatment in patients with increased serum creatinine levels after renal transplant

Zhen-Hong Pan,Ming Li,Yan-Xuan Zhang,Jun Fang,Xin Jiang,Qing-Shan Qu

doi:10.4314/tjpr.v15i5.25

Abstract

Purpose: To observe the clinical effects of sirolimus (SRL) immunosuppressive therapy in patients with progressively increasing levels of serum creatinine (Scr) after renal transplant.Methods: In total, 180 patients whose Scr levels had been rising after renal transplant were given an oral calcineurin inhibitor (CNI): either cyclosporine A (CsA) or tacrolimus (FK506). All patients were treated at People’s Hospital of Zhengzhou, China, between January 2011 and December 2013, and were given SRL-based conversion treatment. Scr level and glomerular filtration rate (GFR) were observed before and 1, 3, and 6 months after treatment initiation. In addition, liver function, blood glucose, blood lipid levels, rejection reaction incidence, and mortality were recorded to evaluate the effects of SRL.Results: Scr levels were 116.60 ± 30.60 μmol/L and 119.00 ± 24.60 μmol/L, and GFR was 70.00 ± 19.70 mL/min and 75.90 ± 15.60 mL/min, at 3 and 6 months after treatment, respectively. The 3- and 6- month Scr and GFR values were statistically different (p < 0.05) compared to pre-treatment levels (Scr: 144.10 ± 61.70 μmol/L vs and GFR: 59.10 ± 16.20 mL/min. Acute rejection (AR) occurred in 20 patients (13.30 %) within 6 months of treatment initiation, but rejection was reversed with conventional methylprednisolone therapy. Twenty-one patients (11.70 %) developed lung infections, but all were cured. There were no significant differences in liver function before and after treatment.Conclusion: SRL-based immunosuppressive therapy is effective in treating patients with increased Scr levels after renal transplant.Keywords: Renal transplant, Serum creatinine, Calcineurin inhibitors, Sirolimus, Acute rejection, Glomerular filtration rate

Highlights

The extensive application of novel immunosuppressors has led to a dramatic reduction in acute rejection (AR) incidence; long-term survival after renal transplant is still not adequate [1,2]
Chronic allograft nephropathy (CAN) is caused by renal toxicity, which can be induced by Calcineurin inhibitors (CNIs) treatment
Serum creatinine (Scr) levels progressively increase after transplantation in kidneys that enter the decompensation period after chronic allograft nephropathy (CAN)

Summary

INTRODUCTION

The extensive application of novel immunosuppressors has led to a dramatic reduction in acute rejection (AR) incidence; long-term survival after renal transplant is still not adequate [1,2]. The development of new immunosuppressors, such as sirolimus (SRL), make it possible to stop CNI treatment [6]. Treating renal transplant patients with immunosuppressive drugs other than CNIs has received more attention in recent years. SRL treatment represents a potential alternative to CNIs for renal transplant patients. The prevention of complications and improvement of long-term survival rates in renal transplant patients has attracted a lot of attention in recent years. Researchers are trying to find an alternative but effective treatment to CNIs. In this study, 180 patients who developed CAN after renal transplant at Zhengzhou People’s Hospital between February 2011 and December 2013 were treated with SRL conversion therapy. Differences were considered statistically significant at p < 0.05

RESULTS

DISCUSSION

CONCLUSION