%0 Journal Article
%T Conversion from Calcineurin Inhibitors to Sirolimus Maintenance Therapy in Renal Allograft Recipients with Risk Factors
%A Shuming Ji
%A Jiqiu Wen
%A Dongrui Cheng
%A Qiquan Sun
%A Jinsong Chen
%A Zhihong Liu
%J Open Journal of Organ Transplant Surgery
%P 8-13
%@ 2163-9493
%D 2011
%I Scientific Research Publishing
%R 10.4236/ojots.2011.11002
%X Background: The efficacy and safety of conversion treatment with sirolimus in renal transplant recipients using the calcineurin inhibitor (CNI) with one or more risk factors was evaluated. Methods: Ninety-three renal transplant recipients were prospectively enrolled. CNIs(CsA and FK506) as main immunosuppressant were converted to SRL immunosuppressant protocol. Rapid conversion with si-rolimus was performed in all patients. The CNI withdrawal was in 2 weeks. At 4 hours after oral administration of cyclosporin A or tacrolimus, the patients took sirolimus. Initial dose of sirolimus was 6 mg, and repeated maintenance dose is 1.0 - 2.0 mg/d. The first concentration of sirolimus was detected at 5 - 7 days after first oral administration, and the target concentration was 6 - 10 ¦̀g/L. Results: The symptoms were markedly improved in patients with CNI induced renal toxicity and CNI induced liver toxicity, and the concentration of sirolimus were maintained at (5.1 ± 1.2) ¦̀g/L. Serum creatinine levels decreased from (297.72 ± 150.28) ¦̀mol/L to (123.76 ± 44.2) ¦̀mol/L, and the liver function were recovery in 24 (92.3%) patients. 9 patients with high glucose returned to normal, and 2 patients were improved. Serum creatinine levels decreased more than 25% of primary level in 17 patients, and the effective rate was 51.5%. 10 patients with tumor were appeared 6 - 43 months after renal transplantation, no recurrence was found in 8 of them and 2 patients were dead. Acute rejections were occurred in 3 patients at 6 months after conversion treatment. The complications were included hyperlipidemia and proteinuria. 3 patients were dead, 6 patients returned to dialysis treatment, and 2 patients were removal of grafts. At 3 years after conversion treatment, the survival rates of patients and grafts were 90.9% and 75.8%, respectively. Conclusion: The conversion treatment with SRL and MMF may be a better option for the renal transplant recipients using the CNI with risk factors appeared.
%K Renal Transplant
%K Calcineurin
%K Inhibitor
%K Conversion
%K Sirolimus
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=7012