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- Title
Influence of sirolimus on proteinuria in de novo kidney transplantation with expanded criteria donors: comparison of two CNI-free protocols.
- Authors
Fritz Diekmann; Alex Gutiérrez-Dalmau; Sonia López; Federico Cofán; Núria Esforzado; MarÃa José Ricart; Esther Rossich; Núria Saval; José Vicente Torregrosa; Federico Oppenheimer; Josep M. Campistol
- Abstract
Background. The contribution of mammalian target of rapamycin (mTOR) inhibitors to proteinuria is controversial. The aim was to analyse proteinuria in suboptimal kidney calcineurin inhibitor-(CNI) free de novo immunosuppression. Methods. All patients from our centre with donors >60 years and CNI-free treatment were included (n = 108). Patients were divided into two groups: (i) SRL group: sirolimus (SRL)â prednisone mycophenolate mofetil (MMF) antiCD25; (ii) MMF group: prednisone MMF w/ or w/o antiCD25 (n = 75). Follow-up was 12 months. Results. Donors were slightly younger in the SRL group (68 vs 71 years; P vs 65 years) was not significantly different. Patient survival in the MMF group was 88 vs 94% in the SRL group, however, these differences did not reach statistical significance. One-year graft survival censored for death was 83% in the MMF group and 94% in the SRL group. Acute rejection rate was 45% in the MMF and 15% in the SRL group (P vs 5; P vs MMF at 12 months: 461 (163â6988) vs 270 (53â3029) mg/day], which did not exist in the on-therapy (OT) analysis [SRL vs MMF at 12 months: 357 (199â1428) vs 279 (53â3029) mg/day]. New onset nephrotic range proteinuria seemed to occur slightly more frequently in SRL patients (3/33 vs 1/75; P = 0.049), however, all four cases occurred in a context of recurrent disease, or previous drug-independent damage or non-adherence. All of these patients were converted to CNI. Conclusion. SRL-based compared with MMF-based treatment in kidney transplantation with advanced age donors is associated with an acceptable outcome, however, with increased proteinuria in the intention-to-treat analysis. A large subgroup of the patients in the MMF group experienced acute rejection and required conversion to CNI.
- Subjects
RAPAMYCIN; IMMUNOSUPPRESSIVE agents; PHARMACODYNAMICS; PROTEINURIA
- Publication
Nephrology Dialysis Transplantation, 2007, Vol 22, Issue 8, p2316
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gfm181