Long-Term Outcomes Following a Calcineurin Sparing Protocol After Renal Transplantation.

Abstract

Despite remarkable advances in early kidney allograft survival rates, improvements in long-term outcomes remain limited primarily due to chronic progressive renal injury. One of the many possible causes of chronic allograft injury is calcineurin inhibitor (CNI) toxicity. To avoid CNI toxicity and to improve graft longevity, patients have been converted to non-CNI immunosuppressive regimens. Due to the anti-fibrotic effects of TORC1 inhibitors, these agents were proposed as non-nephrotoxic options to replace CNI in renal transplantation. Since the lasting consequences of TORC1 inhibitor therapy are not well defined, we report our 9 year experience with a CNI sparing protocol. We reviewed the medical records of all 600 patients transplanted in our center from 2001 to 2011. We compared the outcomes of patients who received continuous CNI based therapy (CNI, n=365) to those who were converted to sirolimus and remained on this drug throughout the study (CONV, n=109). The two groups were similar for recipient and donor characteristics as well as immunosuppressive therapy. Diabetes was more common in the CNI group whereas hypertension and re-transplants were more frequent in the CONV group. Graft and patient survival rates were equivalent in both groups (Fig1). There was no difference in the causes of death. The causes of graft loss were also similar except that recurrent disease was more common in the CONV group. The rate of acute rejection (19.1% CNI vs. 15% CONV, p=0.47) was similar. Renal function was also not different between groups. There was no difference in outcomes in patients converted within or after one year. Therefore, long-term outcomes following renal transplantation are no different whether patients are switched to sirolimus or remain on CNI therapy.Figure: No Caption available.Figure: No Caption available.