Safety and immunologic benefits of conversion to sirolimus in kidney transplant recipients with long-term exposure to calcineurin inhibitors
The Korean Journal of Internal Medicine
;
: 552-559, 2016.
Article
in English
| WPRIM
| ID: wpr-48496
ABSTRACT
BACKGROUND/AIMS:
Sirolimus (SRL) is a promising immunosuppressant replacingcalcineurin inhibitors (CNIs). This study was performed to evaluate the safetyand immunologic benefits of conversion to SRL in stable kidney transplant (KT)recipients exposed to CNIs for long periods.METHODS:
Fourteen CNI-treated KT recipients with stable renal function for morethan 10 years were included. Either 2 or 3 mg per day of SRL was administeredwhile CNIs were reduced by half starting on day 1, and then stopped 2 weeks afterSRL introduction. The safety of SRL conversion was assessed considering thegraft function, acute rejection, and graft loss. Immunologic alterations were measuredvia serial changes of T cell and B cell subsets after SRL conversion. Adverseeffects of SRL conversion were also evaluated.RESULTS:
Conversion to SRL was successful in nine patients (64.2%). Conversionto SRL preserved graft function as compared to the baseline value (p = 0.115). Noacute rejection or allograft loss was observed during the follow-up period. Immunemonitoring of T and B cells revealed a regulatory T cells increase after SRL conversion (p = 0.028). Most adverse events developed within 6 weeks after SRLconversion, and oral mucositis was the main cause of SRL withdrawal.CONCLUSIONS:
Conversion to SRL can be safe and has immunologic benefits in KTrecipients with long-term CNI exposure. Close monitoring of mucocutaneous adverseevents is, however, required in the early period after SRL conversion.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Stomatitis
/
Transplantation
/
B-Lymphocytes
/
Follow-Up Studies
/
B-Lymphocyte Subsets
/
Kidney Transplantation
/
T-Lymphocytes, Regulatory
/
Calcineurin
/
Transplants
/
Sirolimus
Type of study:
Observational study
/
Prognostic study
Limits:
Humans
Language:
English
Journal:
The Korean Journal of Internal Medicine
Year:
2016
Type:
Article
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