There are few data about long-term renal effect of calcineurin inhibitor (CNI) withdrawal and substitution with sirolimus (SRL) after heart transplantation (HTPL). We evaluated long-term effect of SRL-based CNI-free immunosuppression using iothalamate clearance (Ci) test.
Methods and Materials
We evaluated 199 patients whose Ci was followed regularly after HTPL. We excluded patients with combined other organ transplantation, systemic renal disease, irregular follow-up and age <18 years. Patients were classified as SRL group (n=82) if CNI was discontinued and SRL was used >40 months and as CNI group (n=77) if CNI was not discontinued. Patients who used CNI and SRL simultaneously (n=11) or who used SRL <40 months (n=29) were excluded for Ci analysis. We checked baseline Ci before SRL was started and followed at 12, 30, 48 and >60 months later.
Baseline Ci of SRL group was not significantly different between groups. In SRL group, Ci was significantly increased at 12 month (63±23 ml/min/m²) compared to baseline (54±21 ml/min/m², p=0.019) and maintained thereafter. However, Ci was significantly reduced at 30 month (51±16 ml/min/m²) compared to baseline (60±18 ml/min/m², p=0.001) in CNI group. [figure 1] Among 166 patients who tried SRL substitution for CNI, 38 (22.9%) could not tolerate SRL and major causes were lung infiltration (5.4%) and diarrhea (5.4%) followed by malaise (4.8%) and edema (2.4%).
Sirolimus-based CNI-free regimen is useful for the preservation of renal function in long-term follow-up after HTPL. However, as intolerance rate of SRL is significant, careful assessment of side effect in individual patient is mandatory.
© 2013 Published by Elsevier Inc.