Switch to Sirolimus-based immunosuppresion in stable renal transplant recipients

Détails

ID Serval
serval:BIB_05B0BF2535BA
Type
Actes de conférence (partie): contribution originale à la littérature scientifique, publiée à l'occasion de conférences scientifiques, dans un ouvrage de compte-rendu (proceedings), ou dans l'édition spéciale d'un journal reconnu (conference proceedings).
Sous-type
Abstract (résumé de présentation): article court qui reprend les éléments essentiels présentés à l'occasion d'une conférence scientifique dans un poster ou lors d'une intervention orale.
Collection
Publications
Titre
Switch to Sirolimus-based immunosuppresion in stable renal transplant recipients
Titre de la conférence
40th Annual Meeting Swiss Society of Nephrology
Auteur(s)
Nseir G., Venetz J.P, Hadaya K., Buhler L., Martin P.Y., Pascual M.
Adresse
St. Gallen, Switzerland, December 3-5, 2008
ISBN
1424-7860
Statut éditorial
Publié
Date de publication
2008
Peer-reviewed
Oui
Volume
138
Série
Swiss Medical Weekly
Pages
18S
Langue
anglais
Notes
Publication type : Meeting Abstract
Résumé
Purpose: Sirolimus (SRL) has been used to replace calcineurin
inhibitors (CNI) for various indications including CNI-induced toxicity.
The aim of this study was to evaluate the efficacy and safety of
switching from CNI to SRL in stable renal transplant recipients (RTR)
with low grade proteinuria (<1 g/24 h).
Methods and materials: Between 2001 and 2007, 41 patients (20
females, 21 males; mean age 47 ± 13) were switched after a median
time post-transplantation of 73.5 months (range 0.2-273.2 months).
Indications for switch were CNI nephrotoxicity (39%), thrombotic
micro-angiopathy (14.6%), post-transplantation cancer (24.4%), CNI
neurotoxicity (7.4%), or others (14.6%). Mean follow-up after SRL
switch was 23.8±16.3 months. Mean SRL dosage and through levels
were 2.4 ± 1.1 mg/day and 8 ± 2.2 ug/l respectively. Immunosuppressive
regiments were SRL + mycophenolate mofetil (MMF)
(31.7%), SRL + MMF + prednisone (36.58%), SRL + prednisone
(19.51%), SRL + Azathioprine (9.75%), or SRL alone (2.43%).
Results: Mean creatinine decreased from 164 to 143 μmol/l (p <0.03),
mean estimated glomerular filtration rate (eGFR) increased
significantly from 50.13 to 55.01 ml/minute (p <0.00001), mean
systolic and diastolic blood pressure decreased from 138 to 132 mm
Hg (p <0.03) and from 83 to78 mm Hg (p <0.01), but mean proteinuria
increased from 0.21 to 0.63 g/24 h (p <0.001). While mean total
cholesterolemia didn't increased significantly from 5.09 to 5.56
mmol/l (p = 0.06). The main complications after SRL switch were
dermatitis (19.5%), urinary tract infections (24.4%), ankle edema
(13.3%), and transient oral ulcers (20%). Acute rejection after the
switch occurred in 7.3% of patients (n = 3), and 2 acute rejections
were successfully treated with corticosteroids and 1 did not respond
to treatment (not related to switch). SRL had to be discontinued in
17% of patients (2 nephrotic syndromes, 2 severe edema, 1 acute
rejection, 1 thrombotic micro-angiopathy, and 1 fever).
Conclusion: In conclusion, we found that switching from CNI to SRL
in stable RTR was safe and associated with a significant improvement
of renal function and blood pressure. Known side-effects of SRL led
to drug discontinuation in less than 20% of patients and the acute
rejection rate was 7.3%. This experience underlines the importance of
patient selection before switching to SRL, in particular regarding preswitch
proteinuria.
Mots-clé
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Création de la notice
24/08/2010 15:58
Dernière modification de la notice
20/08/2019 12:27
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