ESPN 50th Annual Meeting

ESPN 2017


 
CLINICAL CHARACTERISTICS OF PATIENTS WITH MTORI CONVERSION AND EFFECTS ON RENAL OUTCOME
Nesrin Taş 1 Bora Gülhan 1 Mihriban İnözü 1 Kübra Çeleğen 1 Ali Düzova 1 Fatih Özaltın 1 Rezan Topaloglu 1

1- HACETTEPE UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF PEDIATRIC NEPHROLOGY, ANKARA, TURKEY
 
Introduction:

Sirolimus is an immunosuppressive agent that offers potentially significant benefits for pediatric transplant patients. In this study, we investigated the effects and efficacy of sirolimus in pediatric renal transplant recipients.

Material and methods:

We performed a retrospective analysis of 19 renal transplant recipients who underwent sirolimus/everolimus conversion.

Results:

Between years 2002-2012, 226 patients were transplanted and sirolimus/everolimus was not used as a baseline immunosuppressive therapy. During follow-up, 17 patients (7 girls, 10 males) were converted to sirolimus and 2 patients were converted to everolimus (2 males). Five patients were transplanted from deceased donors and the rest from living related donors. The most common etiology for chronic renal failure was congenital anomalies of kidney and urinary tract (n=8). The median age of transplantation was 10.7 years (IQR; 8.0-14.6). These 19 patients were converted to sirolimus/everolimus at 24.5±19.1 months after transplantation for biopsy-proven interstitial fibrosis/tubular atrophy (IF/TA) (n=7), BK-virus associated nephropathy (BKVAN) (n=4), progressive decline of renal function (n=3), gingival hypertrophy/tremor (n=2), posttransplant lymphoproliferative disease (PTLD) (n=1), cyclosporine nephrotoxicity (n=2). Median follow-up after switch was 33 months (IQR; 14-59 months). Three patients with declining renal function and 6 out of 7 patients with IF/TA had stabilized graft function after sirolimus/everolimus. Patients with BKVAN (n=4) had functioning grafts after sirolimus along with anti-BKV treatment. Patient with PTLD had diminished cervical lymph node sizes and complete remission occured after sirolimus. There was no graft loss during observation period. Most common side effects of sirolimus were hyperlipidemia (n=7), development of proteinuria (n=3), increase in proteinuria (n=2) and they were controlled with angiotensin converting enzyme inhibitors.

Conclusions:

In conclusion, conversion to sirolimus/everolimus is an effective option for selected patients with tolerable side effects.