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  • Title: Sirolimus monotherapy as maintenance immunosuppression: single-center experience in 50 kidney transplant patients.
    Author: Arellano EM, Campistol JM, Oppenheimer F, Rovira J, Diekmann F.
    Journal: Transplant Proc; 2007 Sep; 39(7):2131-4. PubMed ID: 17889115.
    Abstract:
    INTRODUCTION: Chronic allograft nephropathy, cardiovascular mortality, and posttransplant malignancy are complications of conventional immunosuppression after kidney transplantation. We reported the feasibility of maintenance monotherapy with sirolimus (SRL) in a pilot experience. The aim was to study safety and feasibility of SRL maintenance monotherapy in 50 kidney transplant patients. METHODS: All patients from our center with at least 6 months follow-up on SRL monotherapy were included. During the first month after start of SRL monotherapy, follow-up visits were performed weekly, then each month for the following 2 months. Each follow-up visit included a physical exam and laboratory screening. RESULTS: Mean follow-up on SRL monotherapy was 34.7 +/- 14.9 months. The time between transplantation until start of monotherapy was 7.7 +/- 3.3 years. No rejections occurred. During follow-up, two patients died of cardiovascular disease (already diagnosed before monotherapy); one, of previously diagnosed posttransplant malignancy and one, of hepatitis C-related liver failure. Glomerular filtration rate (GFR) was 53 mL/min x 1.73 m2 at start of monotherapy and 50 mL/min x 1.73 m2 after 4 years. Proteinuria was 632 +/- 562 mg/24 hours at 4 years. During the follow-up, no significant changes in the lipid profile, glycemia, or hemoglobin occurred. CONCLUSIONS: Sirolimus monotherapy is safe in a selected group of immunological low-risk patients without increasing the risk of rejection.
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