Early conversion to a sirolimus-based, calcineurin-inhibitor-free immunosuppression in the SMART trial: observational results at 24 and 36 months after transplantation
Early conversion to a calcineurin-inhibitor (CNI)-free maintenance immunosuppression with sirolimus (SRL), mycophenolate mofetil (MMF) and steroids was associated with an improved 1-year renal function as compared with a cyclosporine (CsA)-based regimen (SMART core-study). This observational follow-...
Gespeichert in:
| Hauptverfasser: | , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
10 February 2012
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| In: |
Transplant international
Year: 2012, Jahrgang: 25, Heft: 4, Pages: 416-423 |
| ISSN: | 1432-2277 |
| DOI: | 10.1111/j.1432-2277.2012.01432.x |
| Online-Zugang: | Verlag, kostenfrei, Volltext: http://dx.doi.org/10.1111/j.1432-2277.2012.01432.x Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1432-2277.2012.01432.x 
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| Verfasserangaben: | Markus Guba, Johann Pratschke, Christian Hugo, Bernhard K. Krämer, Andreas Pascher, Katharina Pressmar, Oliver Hakenberg, Michael Fischereder, Jens Brockmann, Joachim Andrassy, Bernhard Banas, Karl-Walter Jauch |
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| 245 | 1 | 0 | |a Early conversion to a sirolimus-based, calcineurin-inhibitor-free immunosuppression in the SMART trial |b observational results at 24 and 36 months after transplantation |c Markus Guba, Johann Pratschke, Christian Hugo, Bernhard K. Krämer, Andreas Pascher, Katharina Pressmar, Oliver Hakenberg, Michael Fischereder, Jens Brockmann, Joachim Andrassy, Bernhard Banas, Karl-Walter Jauch |
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| 520 | |a Early conversion to a calcineurin-inhibitor (CNI)-free maintenance immunosuppression with sirolimus (SRL), mycophenolate mofetil (MMF) and steroids was associated with an improved 1-year renal function as compared with a cyclosporine (CsA)-based regimen (SMART core-study). This observational follow-up describes 132 patients followed up within the SMART study framework for 36 months. At 36 months, renal function continued to be superior in SRL-treated patients [ITT-eGFR36m: 60.88 vs. 53.72 (CsA) ml/min/1.73 m2, P = 0.031]. However, significantly more patients discontinued therapy in the SRL group 59.4% vs.42.3% (CsA). Patient [99% (SRL) vs.97% (CsA) and graft 96% (SRL) vs.94% (CsA)] survival at 36 months was excellent in both arms. There was no difference in late rejection episodes. Late infections and adverse events were similar in both arms except of a higher rate of hyperlipidemia in SRL and a higher incidence of malignancy in CsA-treated patients. In a multivariate analysis, donor age >60 years, S-creatinine at conversion >2 mg/dl, CMV naïve(-) recipients and immunosuppression with CsA were predictive of an impaired renal function at 36 months. Early conversion to a CNI-free SRL-based immunosuppression is associated with a sustained improvement of renal function up to 36 months after transplantation. Patient selection will be key to derive long-term benefit and avoid treatment failure using this mTOR-inhibitor-based immunosuppressive regimen. | ||
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