Abstract
Purpose Kidney dysfunction causes significant morbidity and mortality after lung transplantation. Historically there is a 30-40% incidence of creatinine doubling after lung transplantation. We report our experience using sirolimus for lung transplant recipients with renal insufficiency. Methods We hypothesized that the addition of sirolimus would have a renal function sparing effect by reducing calcineurin inhibitor (CNI) exposure and analyzed data from lung transplant patients who initiated sirolimus between June 2011 and September 2017 at the University of Maryland Medical Center. Results Forty-seven patients received sirolimus because of renal insufficiency (median) creatinine (Cr) 1.58 mg/dL (IQR 1.19 - 1.83). Cr remained stable at 1, 3, and 6 months after sirolimus initiation 1.50 (1.13-1.73); 1.49 (1.2-1.7) and 1.57 (1.21-1.86). CNI exposure was reduced by 34% after sirolimus initiation. FEV1 also remained stable over the six-month study interval; baseline median 2.17 L/sec (1.77-2.66); six month 2.13 (1.67-2.57). Conclusion Sirolimus treatment is associated with stability of lung and renal function in lung transplant recipients with progressive renal insufficiency.
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