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NDT Advance Access published online on August 7, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp386
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Transfer from ciclosporin to mycophenolate-sirolimus immunosuppression for chronic renal disease after heart transplantation: safety and efficacy of two regimens

Haifa Lyster1, Neil Leaver1, Iman Hamour1, Andy Palmer2 and Nicholas R. Banner1,3

1 Department of Transplantation, Royal Brompton & Harefield NHS Trust (Harefield Hospital), Hill End Road, Harefield, Middlesex, UB9 6JH 2 Department of Nephrology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS 3 Imperial College London, South Kensington Campus, London, SW7 2AZ, UK

Correspondence and offprint requests to: Nicholas R. Banner; E-mail: n.banner{at}rbht.nhs.uk



  Abstract

Background. Chronic kidney disease is common after heart transplantation, and is related to ciclosporin (CsA) therapy. We compared the safety and efficacy of two ciclosporin withdrawal regimens.

Methods. CsA was stopped and sirolimus (SRL) commenced immediately and the transfer was covered with prednisolone. Those on azathioprine (AZA) were transferred to MMF. In protocol A, the SRL target concentration was 16 (12–20) ng/ml; in protocol B, the target concentration was 7(5–10) ng/ml, but mycophenolate (MMF) and steroids were commenced prior to the transfer.

Results. Baseline characteristics were similar in both groups except that group B were switched later after transplantation. Renal function improved significantly in both groups; this was maintained up to 1 year. Two patients in group A experienced acute rejection (ISHLT grade 3A or 2R); none was seen in group B. Six patients (46%) remained on protocol A and 22 (85%) remained on protocol B at 1 year.

Conclusions. MMF-SRL substitution resulted in a rapid but partial improvement in renal function; the lower dose SRL regimen was better tolerated.

Keywords: ciclosporin nephrotoxicity; heart transplantation; renal dysfunction; sirolimus

Received for publication: 7.10.08
Accepted in revised form: 8. 7.09


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