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Sirolimus conversion efficacy for graft function improvement and histopathology in renal recipients with mild to moderate renal insufficiency.

Joo DJ, Yang CW, Jeong HJ, Lim BJ, Huh KH, Chung BH, Choi YJ, Kang SW, Kim YS - J. Korean Med. Sci. (2014)

Bottom Line: The effect of SRL conversion on graft function was evaluated, and protocol biopsies were performed preconversion and 1 yr after conversion.In contrast, protocol biopsies demonstrated no significant improvements in the modified "ah" score or other Banff scores after SRL conversion.Furthermore, the duration of CNI treatment prior to SRL conversion was not associated with histological findings 1 yr after SRL conversion.

View Article: PubMed Central - PubMed

Affiliation: The Research Institute for Transplantation, Severance Hospital, Yonsei University Health System, Seoul, Korea. ; Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea.

ABSTRACT
This study was designed to evaluate whether sirolimus (SRL) conversion effectively improves renal function and histopathology in calcineurin inhibitor (CNI)-treated renal recipients with mild to moderate renal insufficiency. SRL conversion from CNI was performed in patients who underwent kidney transplantation from 6 months to 5 yr prior to screening. Forty-five patients were enrolled. The effect of SRL conversion on graft function was evaluated, and protocol biopsies were performed preconversion and 1 yr after conversion. Overall graft function after SRL conversion gradually improved, and the improvement in renal function was closely associated with the shorter duration of CNI exposure. When we divided the patients by the duration of CNI exposure, the patients with less than 1 yr of CNI exposure demonstrated significant improvement, but patients with a greater than 1 yr CNI exposure did not exhibit significant improvement. In contrast, protocol biopsies demonstrated no significant improvements in the modified "ah" score or other Banff scores after SRL conversion. Furthermore, the duration of CNI treatment prior to SRL conversion was not associated with histological findings 1 yr after SRL conversion. SRL conversion improved graft function in renal recipients with mild to moderate renal insufficiency, but this effect is not accompanied by histological improvement.

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Related in: MedlinePlus

Study population. Forty-six patients were screened, and 45 preconversion biopsies were performed. After the 52-week study period, 37 post-conversion biopsies were completed.
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Figure 2: Study population. Forty-six patients were screened, and 45 preconversion biopsies were performed. After the 52-week study period, 37 post-conversion biopsies were completed.

Mentions: The screening was conducted between March 2007 and December 2009. A total of 46 patients who underwent kidney transplantation 6 months to 5 yr prior to the screening time point, were screened. There were 39 living donor and 7 deceased donor kidney transplantations. One screening failure occurred due to a low eGFR under 40 mL/min. Forty-five patients were enrolled in the current study, and preconversion biopsies were performed in all enrolled patients. CNI was completely converted to SRL 4 weeks after loading SRL. Four patients dropped out during the 52-week study period because of one case of acute pancreatitis, one case of severe edema, and two cases of pneumonitis. Thirty-seven protocol biopsies (postconversion biopsy) were completed after the 52-week study period (Fig. 2).


Sirolimus conversion efficacy for graft function improvement and histopathology in renal recipients with mild to moderate renal insufficiency.

Joo DJ, Yang CW, Jeong HJ, Lim BJ, Huh KH, Chung BH, Choi YJ, Kang SW, Kim YS - J. Korean Med. Sci. (2014)

Study population. Forty-six patients were screened, and 45 preconversion biopsies were performed. After the 52-week study period, 37 post-conversion biopsies were completed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129197&req=5

Figure 2: Study population. Forty-six patients were screened, and 45 preconversion biopsies were performed. After the 52-week study period, 37 post-conversion biopsies were completed.
Mentions: The screening was conducted between March 2007 and December 2009. A total of 46 patients who underwent kidney transplantation 6 months to 5 yr prior to the screening time point, were screened. There were 39 living donor and 7 deceased donor kidney transplantations. One screening failure occurred due to a low eGFR under 40 mL/min. Forty-five patients were enrolled in the current study, and preconversion biopsies were performed in all enrolled patients. CNI was completely converted to SRL 4 weeks after loading SRL. Four patients dropped out during the 52-week study period because of one case of acute pancreatitis, one case of severe edema, and two cases of pneumonitis. Thirty-seven protocol biopsies (postconversion biopsy) were completed after the 52-week study period (Fig. 2).

Bottom Line: The effect of SRL conversion on graft function was evaluated, and protocol biopsies were performed preconversion and 1 yr after conversion.In contrast, protocol biopsies demonstrated no significant improvements in the modified "ah" score or other Banff scores after SRL conversion.Furthermore, the duration of CNI treatment prior to SRL conversion was not associated with histological findings 1 yr after SRL conversion.

View Article: PubMed Central - PubMed

Affiliation: The Research Institute for Transplantation, Severance Hospital, Yonsei University Health System, Seoul, Korea. ; Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea.

ABSTRACT
This study was designed to evaluate whether sirolimus (SRL) conversion effectively improves renal function and histopathology in calcineurin inhibitor (CNI)-treated renal recipients with mild to moderate renal insufficiency. SRL conversion from CNI was performed in patients who underwent kidney transplantation from 6 months to 5 yr prior to screening. Forty-five patients were enrolled. The effect of SRL conversion on graft function was evaluated, and protocol biopsies were performed preconversion and 1 yr after conversion. Overall graft function after SRL conversion gradually improved, and the improvement in renal function was closely associated with the shorter duration of CNI exposure. When we divided the patients by the duration of CNI exposure, the patients with less than 1 yr of CNI exposure demonstrated significant improvement, but patients with a greater than 1 yr CNI exposure did not exhibit significant improvement. In contrast, protocol biopsies demonstrated no significant improvements in the modified "ah" score or other Banff scores after SRL conversion. Furthermore, the duration of CNI treatment prior to SRL conversion was not associated with histological findings 1 yr after SRL conversion. SRL conversion improved graft function in renal recipients with mild to moderate renal insufficiency, but this effect is not accompanied by histological improvement.

Show MeSH
Related in: MedlinePlus