Publication:
Sirolimus Attenuates the Rate of Progression of Early Chronic Allograft Nephropathy

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Issued Date

2006

Resource Type

Article

File Type

application/pdf

ISSN

411345

DOI

10.1016/j.transproceed.2006.10.097

Other identifier(s)

2-s2.0-33845452280

Rights Holder(s)

Scopus

Bibliographic Citation

Transplantation Proceedings. Vol 38, No.10 (2006), p.3470-3472

Suggested Citation

Sumethkul V., Changsirikulchai S., Lothuvachai T., Chalermsanyakorn P. Sirolimus Attenuates the Rate of Progression of Early Chronic Allograft Nephropathy. Transplantation Proceedings. Vol 38, No.10 (2006), p.3470-3472. doi:10.1016/j.transproceed.2006.10.097 Retrieved from: https://hdl.handle.net/20.500.14740/5258

Title

Sirolimus Attenuates the Rate of Progression of Early Chronic Allograft Nephropathy

Author(s)

Sumethkul V.
 Changsirikulchai S.
 Lothuvachai T.
 Chalermsanyakorn P.

Abstract

Optimal treatment for patients with chronic allograft nephropathy (CAN) is not known. Early intervention is preferred. We examined the benefit of adding sirolimus (SRL; C0 5-12 ng/mL: HPLC) on the rate of progression of early CAN. We identified patients with biopsy-confirmed Banff grade 1 CAN. After biopsy, patients were switched to SRL + CsA + prednisolone (SRL), MMF + CsA + prednisolone (MMF), or CsA + AZA + prednisolone (AZA). GFR was estimated by Cockcroft-Gault and MDRD formulae. The rate of GFR decline (delta GFR) was determined by calculating the slope of the regression line of estimated GFR (MDRD and Cockcroft-Gault method) at different times. Statistical analysis was performed by the Wilcoxon test. The 41 patients with CAN grade 1 were assigned to SRL: MMF: AZA = 12: 20: 9. Before biopsy; the graft age for SRL: MMF: AZA were 56 ± 27: 70 ± 48: 51 ± 36 months; and the GFR (MDRD method), 38 ± 8: 42 ± 15: 36 ± 14 mL/min; GFR (C-G method) 45 ± 13, 42 ± 12, 41 ± 15 mL/min; trough CsA levels 152 ± 36: 145 ± 46: 177 ± 61 ng/dL; delta GFR (MDRD method) -0.18 ± 0.20: -0.15 ± 0.59: -0.20 ± 1.08; delta GFR (C-G method) -0.13 ± 0.37: -0.19 ± 0.24: -0.65 ± 0.99. Follow-up time for SRL: MMF: AZA was 19 ± 4: 35 ± 32: 59 ± 54 months. At last follow-up; GFR (MDRD method) for SRL: MMF: AZA were 39 ± 13: 35 ± 21: 40 ± 24 mL/min; GFR (C-G method) 46 ± 17, 37 ± 18, 46 ± 25 mL/min; BP 128 ± 11/79 ± 7: 131 ± 22/80 ± 14: 132 ± 20/82 ± 11 mm Hg; and CsA level 52 ± 25: 122 ± 41: 155 ± 49. After biopsy, statin was prescribed in nine SRL, 10 MMF, and three AZA. ACEI was prescribed in two SRL, three MMF, and two AZA. Compared with the prebiopsy values, the delta GFR (MDRD method) changed to -0.04 ± 0.31 (SRL; P = .04), -0.17 ± 0.40 (MMF; P = .60), and -0.97 ± 1.52 (AZA: P = .16). Delta GFR (C-G method) was also significantly improved in the SRL group (-0.02 ± 0.47; P = .05) but not in the MMF (-0.13 ± 0.51; P = .53) or AZA (-0.54 ± 1.78; P = .44). We concluded that patients with early CAN who are switched to SRL and low-dose CsA have a significant attenuation of the rate of GFR declination when compared with patients who receive MMF or AZA addition. © 2006 Elsevier Inc. All rights reserved.

Subject(s)

Azathioprine
 Cyclosporin A
 Dipeptidyl carboxypeptidase inhibitor
 Hydroxymethylglutaryl coenzyme A reductase inhibitor
 Mycophenolic acid 2 morpholinoethyl ester
 Prednisolone
 Rapamycin
 Adult
 Article
 Attenuation
 Blood pressure
 Chronic allograft nephropathy
 Clinical article
 Clinical trial
 Controlled clinical trial
 Controlled study
 Demography
 Disease course
 Drug blood level
 Follow up
 Glomerulus filtration rate
 High performance liquid chromatography
 Human
 Kidney biopsy
 Linear regression analysis
 Prescription
 Priority journal
 Rank sum test
 Rating scale
 Statistical analysis
 Statistical significance
 Adult
 Azathioprine
 Biopsy
 Blood Pressure
 Chronic Disease
 Creatinine
 Cyclosporine
 Disease Progression
 Drug Therapy, Combination
 Glomerular Filtration Rate
 Humans
 Immunosuppressive Agents
 Kidney Function Tests
 Kidney Transplantation
 Middle Aged
 Mycophenolic Acid
 Postoperative Complications
 Sirolimus
 Transplantation, Homologous
 Treatment Outcome

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https://hdl.handle.net/20.500.14740/5258

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