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Sirolimus‐Based Therapy Following Early Cyclosporine Withdrawal Provides Significantly Improved Renal Histology and Function at 3 Years
Author(s) -
Mota Alfredo,
Arias Manuel,
Taskinen Eero I.,
Paavonen Timo,
Brault Yves,
Legendre Christophe,
Claesson Kerstin,
Castagneto Marco,
Campistol Josep M.,
Hutchison Brian,
Burke James T.,
Yilmaz Sedar,
Häyry Pekka,
Neylan John F.
Publication year - 2004
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2004.00446.x
Subject(s) - medicine , regimen , urology , renal function , histology , transplantation , biopsy , kidney transplantation , sirolimus , kidney , gastroenterology , surgery
Graft function and histology are predictive of renal transplant survival. The Rapamune Maintenance Regimen study demonstrated that early cyclosporine (CsA) withdrawal from a sirolimus (SRL)‐CsA‐steroid (ST) regimen improved renal function and blood pressure. We report the protocol‐mandated biopsy findings from that study. Renal transplant patients (n = 430) receiving SRL‐CsA‐ST were randomized at 3 months after transplantation to remain on SRL‐CsA‐ST, or to have CsA withdrawn (SRL‐ST group). Protocol‐mandated biopsies were performed at engraftment and at 12 and 36 months. Two pathologists blindly evaluated 484 biopsies to obtain the Chronic Allograft Damage Index (CADI) scores. At 36 months among patients with serial biopsies (n = 63), the mean CADI score was significantly lower with SRL‐ST(4.70 vs. 3.20, p = 0.003), as was the mean tubular atrophy score (0.77 vs. 0.32, p < 0.001). All six components of the CADI score were numerically lower in SRL‐ST group; moreover, inflammation and the tubular atrophy scores decreased significantly in the SRL‐ST group between 12 and 36 months. The calculated glomerular filtration rate at 36 months was significantly better in the CsA‐withdrawal group (54.8 vs. 68.2 mL/min, p = 0.009). In conclusion, withdrawing CsA from the SRL‐CsA‐ST regimen resulted in improved renal histology and function.