Complete avoidance of calcineurin inhibitors in renal transplantation: A randomized trial comparing sirolimus and tacrolimus

T. S. Larson, P. G. Dean, M. D. Stegall, M. D. Griffin, S. C. Textor, T. R. Schwab, J. M. Gloor, F. G. Cosio, W. J. Lund, W. K. Kremers, S. L. Nyberg, M. B. Ishitani, M. Prieto, J. A. Velosa

Research output: Contribution to journalArticle

242 Scopus citations

Abstract

Calcineurin inhibitors have decreased acute rejection and improved early renal allograft survival, but their use has been implicated in the development of chronic nephrotoxicity. We performed a prospective, randomized trial in kidney transplantation comparing sirolimus-MMF-prednisone to tacrolimus-MMF-prednisone. Eighty-one patients in the sirolimus group and 84 patients in the tacrolimus group were enrolled (mean follow-up = 33 months; range 13-47 months). At 1 year, patient survival was similar in the groups (98% with sirolimus, 96% with tacrolimus; p = 0.42) as was graft survival (94% sirolimus vs. 92% tacrolimus, p = 0.95). The incidence of clinical acute rejection was 10% in the tacrolimus group and 13% in the sirolimus group (p = 0.58). There was no difference in mean GFR measured by iothalamate clearance between the tacrolimus and sirolimus groups at 1 year (61 ± 19 mL/min vs. 63 ± 18 mL/min, p = 0.57) or 2 years (61 ± 17 mL/min vs. 61 ± 19 mL/min, p = 0.84). At 1 year, chronicity using the Banff schema showed no difference in interstitial, tubular or glomerular changes, but fewer chronic vascular changes in the sirolimus group. This study shows that a CNI-free regimen using sirolimus-MMF-prednisone produces similar acute rejection rates, graft survival and renal function 1-2 years after transplantation compared to tacrolimus-MMF-prednisone.

Original languageEnglish (US)
Pages (from-to)514-522
Number of pages9
JournalAmerican Journal of Transplantation
Volume6
Issue number3
DOIs
StatePublished - Mar 1 2006

Keywords

  • Adverse effects
  • Graft survival
  • Immuno-suppression
  • Kidney transplantation
  • Nephrotoxicity
  • Pathology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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