November 28, 2013

Planned Randomized Conversion From Tacrolimus to Sirolimus-Based Immunosuppressive Regimen in De Novo Kidney Transplant Recipients


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While sirolimus has some features that make it an attractive immunosuppressant, it is less effective at preventing acute rejection than calcineurin inhibitors (CnI). An alternate strategy is to use CnI early post-transplant and then switch to sirolimus at some point post-transplant. In this randomized controlled trial, patients with good graft function and no other contraindications were converted from tacrolimus to sirolimus 3 months post-transplant. At 24 months, there was no difference in renal function, or chronic changes on biopsy, and a higher rate of acute rejection. This study, and others like it, question the usefulness of pursuing a CnI-free strategy, at least with sirolimus.

Renal Transplantation

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