Five-year follow-up after conversion from calcineurin inhibitor to sirolimus-based treatment in kidney transplant patients with chronic allograft nephropathy

摘要

Chronic allograft nephropathy (CAN) is a major cause of graft loss in long-term kidney transplant recipients. To identify the safety and efficacy of conversion from calcineurin inhibitors (CNI) to sirolimus (SRL) in patients with CAN, we investigated 92 biopsy demonstrated CAN patients during a 5-year follow-up.45 patients were converted to sirolimus treatment (SRL group) and remaining 47 patients continued CNI immunosuppression (CNI group). Renal function, proteinuria, hepatic function, lipid level and blood routine examination were observed for 60 months in each group. During the period of conversion, serum creatinine was superior in SRL group to CNI group. It dropped significantly from (174.0 ± 62.8) umol/L to (150.7 ± 83.4) umol/L in SRL group whereas increased to (200.9 ± 73.5) umol/L in CNI group (P < 0.05). However, SRL group showed increased proteinuria, triglycerides and decreased Plt (P < 0.05). We also found those patients in SRL group with a good baseline of renal function (serum creatinine < 200 umol/L or proteinuria < 800 mg/day at conversion) would ameliorate the impaired renal function from CAN at 60 months. In conclusion, it is safe and effective to convert from CNI to SRL for patients with CAN in our long-term observation. Early conversion is associated with an improvement of renal function.