Conversion therapy ofsirolimus in expanded standard renal transplant recipients

Abstract

Objective To evaluate the efficacy and safety of converting traditional triple immunosuppressive regimen into quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid plus hormone in expanded criteria donor (ECD) renal transplant recipients. Methods A retrospective analysis was conducted for 39 patients undergoing extended standard kidney transplantation with conversion therapy from January 2015 to June 2018. Renal function, liver function, blood lipid, bone marrow suppression, positive rate of urinary protein, positive rate of urinary BK virus and other adverse reactions were analyzed. Results A total of 39 recipients fulfilled the inclusion criteria, including 28 boys and 11 girls with an average age of (37.69±11.07) years and a median postoperative conversion time of 6 months. As compared with pre-conversion therapy, renal function and estimated glomerular filtration rate improved significantly at 1 month, 3 months, 6 months and 1 year (P 0.05). No significant difference existed between AST and ALT at pre and post-conversion (P<0.05). After conversion, the positive rates of urinary protein and BK virus urine declined. Subacute rejection occurred in 1 case after conversion. Addition of sirolimus was curative. No severe adverse reactions such as infection and diarrhea occurred in the remaining cases. Conclusions The quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid and hormone is both safe and effective for ECD recipients of renal transplantation. Key words: Kidney transplantation; Expanded criteria donor; Sirolimus; Tacrolimus; Conversion therapy