Preservation of graft function in low-risk living kidney transplant recipients treated with a combination of sirolimus and cyclosporine

Brazilian Journal of Medical and Biological Research

P.g.p. Machado²  C.r. Felipe²  S.i. Park²  R. Garcia²  S. Moreira²  D. Casarini²  M. Franco¹  F. Alfieri¹  H. Tedesco-silva Jr.²  J.o. Medina-pestana² 

[1] ,Universidade Federal de São Paulo Hospital do Rim e Hipertensão Divisão de Nefrologia

关键词: Sirolimus;    Cyclosporine;    Graft function;    Immunosuppression;    Kidney transplantation;   

DOI  :  10.1590/S0100-879X2004000900004

来源: SciELO

【 摘 要 】

The use of sirolimus (SRL) in combination with full doses of cyclosporin A (CsA) results in reduced one-year kidney allograft function, which is associated with shorter long-term allograft survival. We determined the effect of reduced CsA exposure on graft function in patients receiving SRL and prednisone. Ninety recipients of living kidney transplants receiving SRL (2 mg/day, po) were compared to 35 recipients receiving azathioprine (AZA, 2 mg kg-1 day-1, po). All patients also received CsA (8-10 mg kg-1 day-1, po) and prednisone (0.5 mg kg-1 day-1). Efficacy end-point was a composite of biopsy-confirmed acute rejection, graft loss, or death at one year. Graft function was measured by creatinine, creatinine clearance, and graft function deterioration between 3 and 12 months (delta1/Cr). CsA concentrations in patients receiving SRL were 26% lower. No differences in one-year composite efficacy end-point were observed comparing SRL and AZA groups (18 vs 20%) or in the incidence of biopsy-proven acute rejection (14.4 and 14.3%). There were no differences in mean ± SD creatinine (1.65 ± 0.46 vs 1.60 ± 0.43 mg/dl, P = 0.48) or calculated creatinine clearances (61 ± 15 vs 62 ± 13 ml/min, P = 0.58) at one year. Mean ± SD delta1/Cr (-11 ± 17 vs -14 ± 15%, P = 0.7) or the percentage of patients with >20% (26 vs 31%, P = 0.6) or >30% delta1/Cr (19 vs 17%, P = 1) did not differ between the two groups. The use of 2-mg fixed oral doses of SRL and reduced CsA exposure was effective in preventing acute rejection and preserving allograft function.

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