+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Late conversion to mammalian target of rapamycin inhibitor/proliferation signal inhibitors in kidney transplant patients: clinical experience in the last 5 years



Late conversion to mammalian target of rapamycin inhibitor/proliferation signal inhibitors in kidney transplant patients: clinical experience in the last 5 years



Transplantation Proceedings 42(8): 2859-2860



Treatment with proliferation signal inhibitors (PSIs; sirolimus/everolimus) is a therapeutic option for renal transplant recipients, especially those who develop chronic graft nephropathy (CGN) or a neoplasm. We sought to analyze the efficacy and safety of conversion to PSIs. We undertook a retrospective study of 77 patients converted between January 2005 and October 2009 to PSIs: 53 sirolimus and 24 everolimus. The causes for conversion were 63% tumors, 30% for chronic graft nephropathy (CGN), and 7% for other reasons. Mean time from transplant to conversion was 8 years. Patients were followed for a mean of 18 months (range, 1-61). A significant 14% improvement in renal function was observed at 1 year after conversion: baseline Modification of Diet in Renal Disease (MDRD) 45±20 versus 51±20.1 mL/min/1.73 m2 (P=.03). The benefit was greater among patients converted for CGN: baseline MDRD 31.5±8.8 versus 40.9±13.1 mL/min/1.73 m2 (P=.02), a 30% increase. The side effects experienced by 40% of patients included: 12% diarrhea, 15% edema, 20% buccal aphthae, 10% pneumonitis, and 20% skin alterations. PSIs were withdrawn in 25% of patients: 13% for side effects, 2.5% for patient death, and 3.8% for graft loss. We observed increases in serum lipids and proteinuria with a mild decrease in hemoglobin. Conversion to PSIs is a safe, useful therapeutic option for carefully selected patients, when renal function has not undergone marked deterioration and there is no proteinuria. Although side effects are common, most are mild; withdrawal of PSIs was necessary in a relatively low percentage of cases.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 054084070

Download citation: RISBibTeXText

PMID: 20970551

DOI: 10.1016/j.transproceed.2010.07.062


Related references

A systematic review of conversion from calcineurin inhibitor to mammalian target of rapamycin inhibitors for maintenance immunosuppression in kidney transplant recipients. American Journal of Transplantation 14(9): 2106-2119, 2015

Nonmelanoma Skin Cancers After Kidney Transplant: Our 15 Years of Experience With Mammalian Target of Rapamycin Inhibitors. Experimental and Clinical Transplantation 15(Suppl 1): 236-239, 2017

Conversion of calcineurin inhibitors with mammalian target of rapamycin inhibitors after kidney transplant. Experimental and Clinical Transplantation 11(1): 12-16, 2013

Conversion to mammalian target of rapamycin inhibitors in kidney transplant recipients with de novo cancers. Oncotarget 8(27): 44833-44841, 2017

Conversion from calcineurin inhibitor-based immunosuppression to mammalian target of rapamycin inhibitors or belatacept in renal transplant recipients. Clinical Transplantation 28(11): 1209-1224, 2015

Oedema, solid organ transplantation and mammalian target of rapamycin inhibitor/proliferation signal inhibitors (mTOR-I/PSIs). Clinical Kidney Journal 7(2): 115-120, 2015

Systemic meta-analysis assessing the short term applicability of early conversion to mammalian target of rapamycin inhibitors in kidney transplant. World Journal of Transplantation 7(2): 144-151, 2017

Mammalian Target of Rapamycin Inhibitors and Clinical Outcomes in Adult Kidney Transplant Recipients. Clinical Journal of the American Society of Nephrology 11(10): 1845-1855, 2016

Low-dose calcineurin inhibitor regimen combined with mammalian target of rapamycin inhibitors preserves kidney functions in renal transplant recipients without allograft nephropathy. Transplantation Proceedings 42(9): 3513-3516, 2011

Clinical outcomes in kidney transplant recipients receiving long-term therapy with inhibitors of the mammalian target of rapamycin. American Journal of Transplantation 12(2): 379-387, 2012

Pubertal Development in Pediatric Kidney Transplant Patients Receiving Mammalian Target of Rapamycin Inhibitors or Conventional Immunosuppression. Transplantation 100(11): 2461-2470, 2016

Immunosuppression with mammalian target of rapamycin inhibitor and incidence of post-transplant cancer in kidney transplant recipients. Nephrology, Dialysis, Transplantation 31(8): 1360-1367, 2017

Conversion From Calcineurin Inhibitors to Mammalian Target-of-Rapamycin Inhibitors in Heart Transplant Recipients: A Meta-Analysis of Randomized Controlled Trials. Transplantation Proceedings 47(10): 2952-2956, 2016

Mammalian target of rapamycin inhibitor dyslipidemia in kidney transplant recipients. American Journal of Transplantation 8(7): 1384-1392, 2008

Clinical Experience of Late Conversion From Antimetabolites With Standard Exposure Calcineurin Inhibitors to Everolimus With Calcineurin Inhibitor Minimization in Stable Kidney Transplant Recipients With Good Renal Function. Transplantation Proceedings 48(3): 775-780, 2017