Abstract
Objective To investigate the efficacy and the safety of conversion from cyclosporine A to sirolimus in management of chronic renal allograft dysfunction in kidney allograft recipients. Methods Twenty kidney recipients with chronic renal allograft dysfunction underwent abrupt cessation of cyclosperine A and sirolimus addition, meanwhile the doses of mycophenolate mofetil and prednisolone remained unchanged. Nine cases were randomly identified as the control group. Serum creatinine,glomerular filtration rate (GFR),24-h urine protein and the adverse events associated with sirolimus were analyzed. Results There were no significant differences in age, gender, the transplant duration and pre-conversion immunosuppressants between the conversion group and the control group. After follow-up for 12 months, 18 patients in the conversion group completed the study. Among the 18 patients,11 (61.1 %) were identified with improved or stable serum creatinine and GFR, while 7 (38.9 %) with progressive deterioration of serum creatinine and GFR. The analysis showed significant difference in serum creatinine, GFR, the transplant duration and 24-h urine protein at conversion between the successful conversion group and the invalid conversion group. One patient experienced acute rejection episode,and was alleviated with the impulse of bulk methylprednisolone. Among the 18 patients, infection (2/18), rash (3/18), diarrhea (3/18), dental ulcer (2/18), myelosuppression (8/18), increased transaminase (6/18), hyperlipemia (10/18) and hypopotassemia (4/18) were observed and no one exited the study because of the above adverse effects. Conclusion The conversion from cyclosporine A to sirolimus is recommended in kidney transplant recipients with chronic allograft dysfunction, who received cyclosporine A-based immunosuppression protocol before the conversion, and some may get much benefit from the conversion, but the conversion should be performed before the deterioration of allograft function is too far advanced. Key words: Transplants; Kidney failure, chronic; Sirolimus; Cyclosporine
Published Version
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