OBJECTIVE: Nephrotoxicity is a serious adverse effect after liver transplantation often related to calcineurin inhibitors (CNI) with a incidence of 18.1% at 5 years. Sirolimus (SRL) is a new immunosuppressive drug that was introduced into solid organ transplant management in 1999. Herein we have performed a retrospective review of patients who developed renal insufficiency owing to CNI therapy after orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Thirty-one patients were switched to SRL monotherapy because of nephrotoxicity as evidenced by serum creatinine levels (SCr) > 1.8 mg/dL and estimated glomerular filtration rates (eGFR) < 45 mL/min/1.73 m(2). The dosage was adjusted to achieve trough levels between 8 and 10 ng/mL. RESULTS: The patients were followed for a mean of 52 months (range 2-88 months) after OLT. Mean follow-up after the switch was 27.5 months (range, 2-71.2 months). Immunosuppression was switched after a mean of 35.2 months (range, 0.2-43.4 months). Renal function was significantly improved, as shown by the improved SCr, urea, and eGFR after the switch. CONCLUSIONS: CNIs may be associated with significant nephrotoxicity and chronic kidney damage. Patients who develop renal dysfunction after OLT may be successfully treated by an early switch from CNIs to SRL, stopping the progression toward chronic renal damage and preserving allograft survival.

Immunosuppressive Switch to Sirolimus in Renal Dysfunction After Liver Transplantation / DI BENEDETTO, Fabrizio; Di Sandro, S; De Ruvo, N; Montalti, R; Guerrini, GP; Ballarin, R; Spaggiari, Mario; Mimmo, A; D'Amico, G; Cautero, N; Iemmolo, RM; Gerunda Giorgio, Enrico.. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 41:4(2009), pp. 1297-1299. [10.1016/j.transproceed.2009.03.018]

Immunosuppressive Switch to Sirolimus in Renal Dysfunction After Liver Transplantation

Di Benedetto Fabrizio;Di Sandro S;Ballarin R;Spaggiari Mario;Gerunda Giorgio Enrico.
2009

Abstract

OBJECTIVE: Nephrotoxicity is a serious adverse effect after liver transplantation often related to calcineurin inhibitors (CNI) with a incidence of 18.1% at 5 years. Sirolimus (SRL) is a new immunosuppressive drug that was introduced into solid organ transplant management in 1999. Herein we have performed a retrospective review of patients who developed renal insufficiency owing to CNI therapy after orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Thirty-one patients were switched to SRL monotherapy because of nephrotoxicity as evidenced by serum creatinine levels (SCr) > 1.8 mg/dL and estimated glomerular filtration rates (eGFR) < 45 mL/min/1.73 m(2). The dosage was adjusted to achieve trough levels between 8 and 10 ng/mL. RESULTS: The patients were followed for a mean of 52 months (range 2-88 months) after OLT. Mean follow-up after the switch was 27.5 months (range, 2-71.2 months). Immunosuppression was switched after a mean of 35.2 months (range, 0.2-43.4 months). Renal function was significantly improved, as shown by the improved SCr, urea, and eGFR after the switch. CONCLUSIONS: CNIs may be associated with significant nephrotoxicity and chronic kidney damage. Patients who develop renal dysfunction after OLT may be successfully treated by an early switch from CNIs to SRL, stopping the progression toward chronic renal damage and preserving allograft survival.
41
4
1297
1299
Immunosuppressive Switch to Sirolimus in Renal Dysfunction After Liver Transplantation / DI BENEDETTO, Fabrizio; Di Sandro, S; De Ruvo, N; Montalti, R; Guerrini, GP; Ballarin, R; Spaggiari, Mario; Mimmo, A; D'Amico, G; Cautero, N; Iemmolo, RM; Gerunda Giorgio, Enrico.. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 41:4(2009), pp. 1297-1299. [10.1016/j.transproceed.2009.03.018]
DI BENEDETTO, Fabrizio; Di Sandro, S; De Ruvo, N; Montalti, R; Guerrini, GP; Ballarin, R; Spaggiari, Mario; Mimmo, A; D'Amico, G; Cautero, N; Iemmolo, RM; Gerunda Giorgio, Enrico.
File in questo prodotto:
File Dimensione Formato  
10.pdf

non disponibili

Tipologia: Post-print dell'autore (bozza post referaggio)
Dimensione 98.12 kB
Formato Adobe PDF
98.12 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11380/1202108
Citazioni
  • ???jsp.display-item.citation.pmc??? 5
  • Scopus 7
  • ???jsp.display-item.citation.isi??? 9
social impact