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Conversion from calcineurin inhibitors to sirolimus in transplant‐associated thrombotic microangiopathy
Author(s) -
Kanunnikov Mikhail M.,
Rakhmanova Zhemal Z.,
Levkovsky Nikita V.,
Vafina Aliya I.,
Goloshapov Oleg V.,
Shchegoleva Tatiana S.,
Vlasova Julia J.,
Paina Olesya V.,
Morozova Elena V.,
Zubarovskaya Ludmilla,
Kulagin Alexander D.,
Moiseev Ivan
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14180
Subject(s) - sirolimus , medicine , calcineurin , thrombotic microangiopathy , urology , immunosuppression , transplantation , gastroenterology , disease
Transplant‐associated thrombotic microangiopathy (TA‐TMA) is a specific complication of allogeneic hematopoietic cell transplantation with a multifactorial etiology. There is little evidence published regarding the efficacy and factors influencing the outcome of substitution of calcineurin inhibitors (CNIs) with other agentsas a widely accepted practice in this disorder; however, there are limited data on the options for immunosuppression manipulation (ISM). In our study, we retrospectively analyzed outcomes of 45 patients with TA‐TMA with ISM and substitution either with steroids (steroid group) or anmTOR inhibitor sirolimus (sirolimus group). In our study, sirolimus was associated with significantly better 1‐year overall survival (HR 0.3, 95% CI 0.13‐0.7, p = .004) and faster time to normalization of LDH (HR 2.2, 95% CI 0.99‐4.99, p = .044). Replacing CNIs with sirolimus could be an effective option in patients with TA‐TMA. A multicenter confirmatory study of CNIs replacement with sirolimus is justified.