Long-term outcome of sirolimus rescue in kidney-pancreas transplantation
| Autor: | G.M. Baillie, P. R. Rajagopalan, D.J. Taber, Angello Lin, R.C Pullatt, Elizabeth E. Ashcraft, Jeffrey Rogers, Osemwegie E. Emovon, S Alvarez, P.K. Baliga, Kenneth D. Chavin, Fuad Afzal |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Time Factors Urinary system Urology chemistry.chemical_compound medicine Humans Antibacterial agent Retrospective Studies Sirolimus Transplantation Creatinine Kidney business.industry Mycophenolic Acid Kidney Transplantation Tacrolimus Surgery medicine.anatomical_structure Treatment Outcome chemistry Pancreas Transplantation Pancreas business Immunosuppressive Agents medicine.drug Follow-Up Studies |
| Zdroj: | Transplantation proceedings. 36(4) |
| ISSN: | 0041-1345 |
| Popis: | The aim of this study was to evaluate long-term outcome of sirolimus (SRL) rescue in kidney-pancreas transplantation (KPTx). We reviewed 112 KPTx performed at our institution from 12/3/95 to 6/27/02. All patients received antibody (Ab) induction, tacrolimus (TAC), mycophenolate mofetil (MMF), and steroids. Thirty-five patients (31%) had SRL substituted for MMF for the following indications: (1) acute rejection (AR) of kidney or pancreas despite adequate TAC levels; (2) intolerance of full-dose MMF; (3) rising creatinine; and (4) TAC-induced hyperglycemia. Target SRL and TAC levels were 10 ng/mL and 5 ng/mL, respectively. Mean follow-up was 3 +/- 2 years overall and 1.2 +/- 0.5 years after SRL rescue. No patients died. One- and 3-year actuarial kidney and pancreas graft survival was 97%, 97%, and 95%, 90%, respectively. Of 10 patients switched to SRL for AR, 1 kidney failed from Ab-resistant AR, 1 kidney developed borderline AR, and the other 8 remain AR-free. Seven other patients developed AR despite therapeutic SRL levels; of these, 6 (86%) had mean TAC levels of4.5 in the month preceding AR. Mean creatinine overall and for the rising creatinine group remained stable. All patients switched to SRL for TAC-induced hyperglycemia or MMF intolerance demonstrated biochemical or clinical improvement. Sirolimus-related infection or other serious adverse events (SAE) were uncommon. In conclusion, KPTx recipients can be safely switched to SRL with long-term stabilization of renal function, excellent graft and patient survival, and no increase in SAE. A minimum TAC level of 4.5 ng/mL may be necessary to prevent late AR. |
| Databáze: | OpenAIRE |
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