KidneyOutcomePreemptive Use of Mammalian Target of Rapamycin Inhibitors in Living Donor Transplantation

Sirolimus (SRL) has demonstrated beneficial impacts on the development of chronic allograft dysfunction (CAD). In living donor transplantation, strategies mostly seek to prevent graft dysfunction and respond to a decline in renal function. The present study focused on proactive, preemptive SRL administration for patients with repeated renal transplantations and those engrafted with an extended criteria donor organ.Material and MethodsThis retrospective, monocenter study describes 7 renal transplant recipients with stable graft function receiving SRL within the first year posttransplantation and 3 recipients of second transplantations who started SRL treatment before obtaining their repeat grafts.ResultsA proactive use of SRL revealed stable renal function parameters at 1 year after SRL introduction: Creatinine 1.33 ± 0.21 mg/dL; Modification of Diet in Renal Disease (MDRD) equation glomerular filtration rate, 57 ± 19 mL/min; PU 452 ± 338 mg/24 hours. Cell counts, hemoglobin concentrations, as well as triglyceride and total cholesterol levels did not differ over the 1-year follow-up. SRL administration before retransplantation provided good graft survival and renal function with a creatinine of 1.2 ± .32 mg/dL, MDRD of 60 ± 28 mg/dL, and PU 502 ± 432 mg/24 hour. Cell counts, hemoglobin concentrations, as well as triglyceride and total cholesterol levels did not differ over 1-year follow-up.ConclusionPreemptive SRL-induction before signs of graft deterioration or chronic injury may be a useful approach to prevent CAD.