BACKGROUND: Calcineurin inhibitors (CNI) are the main immunosuppressive drugs in solid organ transplantation. However, their use is hampered by side effects like nephrotoxicity. We report an exceptional experience with three children treated with sirolimus after combined liver and kidney transplantation with prolonged renal failure and CNI-associated nephrotoxicity. PATIENTS AND RESULTS: Two girls experienced prolonged renal graft failure after combined liver-kidney transplantation for 11 and 12 weeks. Repeated biopsies did not show any rejection but did exhibit tubular damage and acute CNI-toxicity. A boy with hyperoxaluria after liver and (a third) renal transplantation experienced acute renal graft failure after an early steroid-resistant rejection. All children were switched to sirolimus-based immunosuppression and cessation of CNI therapy, which was followed by rapid improvement of renal function. Rejection of liver or kidney did not occur after CNI withdrawal. Sirolimus was commenced with 3 mg/m2/day in two doses and resulted in reasonable drug exposure. However, drug monitoring was required to adjust sirolimus dosage. SUMMARY: Prolonged renal failure after transplantation with severe CNI toxicity may be salvaged successfully with sirolimus-based immunosuppression.
BACKGROUND: Calcineurin inhibitors (CNI) are the main immunosuppressive drugs in solid organ transplantation. However, their use is hampered by side effects like nephrotoxicity. We report an exceptional experience with three children treated with sirolimus after combined liver and kidney transplantation with prolonged renal failure and CNI-associated nephrotoxicity. PATIENTS AND RESULTS: Two girls experienced prolonged renal graft failure after combined liver-kidney transplantation for 11 and 12 weeks. Repeated biopsies did not show any rejection but did exhibit tubular damage and acute CNI-toxicity. A boy with hyperoxaluria after liver and (a third) renal transplantation experienced acute renal graft failure after an early steroid-resistant rejection. All children were switched to sirolimus-based immunosuppression and cessation of CNI therapy, which was followed by rapid improvement of renal function. Rejection of liver or kidney did not occur after CNI withdrawal. Sirolimus was commenced with 3 mg/m2/day in two doses and resulted in reasonable drug exposure. However, drug monitoring was required to adjust sirolimus dosage. SUMMARY:Prolonged renal failure after transplantation with severe CNI toxicity may be salvaged successfully with sirolimus-based immunosuppression.
Authors: M Giral-Classe; M Hourmant; D Cantarovich; J Dantal; G Blancho; P Daguin; D Ancelet; J P Soulillou Journal: Kidney Int Date: 1998-09 Impact factor: 10.612
Authors: M Broyer; F P Brunner; H Brynger; S R Dykes; J H Ehrich; W Fassbinder; W Geerlings; G Rizzoni; N H Selwood; G Tufveson Journal: Nephrol Dial Transplant Date: 1990 Impact factor: 5.992
Authors: Hemangshu Podder; Stanislaw M Stepkowski; Kimberly L Napoli; James Clark; Regina R Verani; Ting-Chao Chou; Barry D Kahan Journal: J Am Soc Nephrol Date: 2001-05 Impact factor: 10.121
Authors: Giovanni Stallone; Salvatore Di Paolo; Antonio Schena; Barbara Infante; Michele Battaglia; Pasquale Ditonno; Loreto Gesualdo; Giuseppe Grandaliano; Francesco Paolo Schena Journal: J Am Soc Nephrol Date: 2004-01 Impact factor: 10.121