Conversion to sirolimus for chronic renal allograft dysfunction: risk factors for graft loss and severe side effects
Identifieur interne : 000144 ( France/Analysis ); précédent : 000143; suivant : 000145Conversion to sirolimus for chronic renal allograft dysfunction: risk factors for graft loss and severe side effects
Auteurs : Daniel Abramowicz [Belgique] ; Karine Hadaya [Belgique] ; Marc Hazzan [France] ; Nilufer Broeders [Belgique] ; Anh-Dung Hoang [Belgique] ; Lidia Ghisdal [Belgique] ; Christian Noel [France] ; Karl Martin Wissing [Belgique]Source :
- Nephrology Dialysis Transplantation [ 0931-0509 ] ; 2008-11.
Abstract
We retrospectively reviewed our experience with 45 kidney transplant recipients (KTR) that were switched from CNI to SRL, mainly for chronic allograft dysfunction (CAD) (4145). The mean serum creatinine at switch was 2.5 0.8 mgdl. At 1 year, patient survival was 93. Death-censored graft survival was 67 at 1 year and 54 at 2 years. SRL was stopped because of severe side effects in 15 patients. Among these, eight patients developed de novo high-grade proteinuria. Univariate analysis revealed that (1) a higher SRL level at 1 month was a predictor of SRL withdrawal due to severe side effects (P 0.006), and (2) predictors of graft failure after SRL conversion were low SRL loading dose (P 0.03) and a higher creatinine level at conversion (P 0.003). In conclusion, the therapeutic index of SRL in patients suffering from CAD is narrow, with high exposure triggering serious adverse events that may mandate SRL discontinuation, while too low exposure may expose patients to under-immunosuppression and graft loss.
Url:
DOI: 10.1093/ndt/gfn332
Affiliations:
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ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">We retrospectively reviewed our experience with 45 kidney transplant recipients (KTR) that were switched from CNI to SRL, mainly for chronic allograft dysfunction (CAD) (4145). The mean serum creatinine at switch was 2.5 0.8 mgdl. At 1 year, patient survival was 93. Death-censored graft survival was 67 at 1 year and 54 at 2 years. SRL was stopped because of severe side effects in 15 patients. Among these, eight patients developed de novo high-grade proteinuria. Univariate analysis revealed that (1) a higher SRL level at 1 month was a predictor of SRL withdrawal due to severe side effects (P 0.006), and (2) predictors of graft failure after SRL conversion were low SRL loading dose (P 0.03) and a higher creatinine level at conversion (P 0.003). In conclusion, the therapeutic index of SRL in patients suffering from CAD is narrow, with high exposure triggering serious adverse events that may mandate SRL discontinuation, while too low exposure may expose patients to under-immunosuppression and graft loss.</div></front></TEI><affiliations><list><country><li>Belgique</li><li>France</li></country><region><li>Région de Bruxelles-Capitale</li></region><settlement><li>Bruxelles</li><li>Lille</li></settlement></list><tree><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Abramowicz, Daniel" sort="Abramowicz, Daniel" uniqKey="Abramowicz D" first="Daniel" last="Abramowicz">Daniel Abramowicz</name></region><name sortKey="Broeders, Nilufer" sort="Broeders, Nilufer" uniqKey="Broeders N" first="Nilufer" last="Broeders">Nilufer Broeders</name><name sortKey="Ghisdal, Lidia" sort="Ghisdal, Lidia" uniqKey="Ghisdal L" first="Lidia" last="Ghisdal">Lidia Ghisdal</name><name sortKey="Hadaya, Karine" sort="Hadaya, Karine" uniqKey="Hadaya K" first="Karine" last="Hadaya">Karine Hadaya</name><name sortKey="Hoang, Anh Dung" sort="Hoang, Anh Dung" uniqKey="Hoang A" first="Anh-Dung" last="Hoang">Anh-Dung Hoang</name><name sortKey="Wissing, Karl Martin" sort="Wissing, Karl Martin" uniqKey="Wissing K" first="Karl Martin" last="Wissing">Karl Martin Wissing</name></country><country name="France"><noRegion><name sortKey="Hazzan, Marc" sort="Hazzan, Marc" uniqKey="Hazzan M" first="Marc" last="Hazzan">Marc Hazzan</name></noRegion><name sortKey="Noel, Christian" sort="Noel, Christian" uniqKey="Noel C" first="Christian" last="Noel">Christian Noel</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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