Long-term clinical outcomes of late conversion to once-daily tacrolimus and sirolimus combination in stable kidney transplant recipients

초록

Introduction: The use of calcineurin inhibitors (CNIs) has significantly improved graft outcomes in kidney transplantation (KT); however, nephrotoxicity resulting from their prolonged use presents a significant clinical concern that must not be overlooked. Although CNIs minimization combined with mTOR inhibitors has been introduced to reduce nephrotoxic effects from CNIs, apprehensions regarding under-immunosuppression remain prevalent. This study aimed to evaluated the long-term clinical outcomes of late conversion to once-daily tacrolimus and sirolimus regimen in stable KT recipients. Methods: We conducted a retrospective review of 35 patients who underwent conversion from twice-daily tacrolimus and MMF to a once-daily combination of tacrolimus and sirolimus, along with 35 non-conversion patients, at Korea University Anam Hospital from January 2009 to December 2012, covering a span of 10 years and including laboratory findings. Results: Donors and recipients’ characteristics were similar between two group. There was somewhat better serum creatinine (sCr) levels and estimated glomerular filtration rate (eGFR) over the course of a decade in the conversion group with no statistical significance. The incidence of biopsy-proven acute rejections and infections were not significantly different between two groups. The re-conversion rate to the original regimen, due to various reasons such as proteinuria, oral ulcer, etc. was quite high at 34.3%. Conclusion: Based on the long-term clinical outcomes, a once-daily tacrolimus and sirolimus combination could be considered as an attractive alternative to the conventional regimen with the expection better renal functions, despite a high re-conversion rate due to various reluctant reasons.