SIROLIMUS RESCUE THERAPY FOR NEUROTOXICITY AND NEPHROTOXICITY SECONDARY TO THE USE OF CALCINEURIN INHIBITORS AFTER THE ORTHOTOPIC LIVER TRANSPLANTATION
Makaleler > Tam Makale · 2004
Yazarlar: O Unalp, A Celebi, M Akyldz, Abdullah Zeki KARASU, V Tanil, M Zeytunlu, Y Yuzer, Y Tokat, M Kilic
Transplantation, Uluslararası, Wos, 2004, cilt 78, ss 381-381
DOI: 10.1097/00007890-200407271-01020
Özet
P525 Aims: Although allograft rejection continues to be an important problem after the solid organ transplantation, calcineurin inhibitors have dramatically improved graft survival rate. Immunosuppression following organ transplantation must accomplish a balance between the beneficial effects of the drugs in preventing rejection of the graft and dangers of the over immunosuppression with the development of the side effects. Neurotoxicity and nephrotoxicity are the most clinically significant side effects of calcineurin inhibitors. Sirolimus is a new promising immunosuppressive drug that has been shown to be effective in preventing the acute rejection by experimental and clinical studies. Methods: Between the dates of Februrary 1997and March 2004 16 patients among 303 patients which were administered sirolimus after liver transplantation were studied retrospectively. During this time period 154 cadaveric and 149 Living donor liver transplantations were performed. Patients having nephrotoxicity or neurotoxicity secondary to calcineurin inhibitors were switched to sirolimus started 5 mg/day loading dose and maintained 2 mg/day aiming a trough level of 5-10 ng/dl. Steroids were used as an adjuvant immunosuppressant from day 0 and was tapered to zero in 6 months time. Results: 2 of the 15 patients having the side effect of neurotoxicity after the application of calcineurin inhibitors improved rapidly. The median creatinine levels were 2,05mg/dl in 13 patients having nephrotoxicity before switching the immunosuppression and came down to 1,4mg/dl a month after (p<0.02). 3 of these patients were lost due to reasons other than immunosuppressive side effects and the remaining 12 patients are well and have stable liver functions with a median follow-up of 19 months. In 3 patients having mild rejection episodes sirolimus was combined with low dose cyclosporin. We did not encounter any significant dislipidemia requiring medication or bone marrow suppression due to sirolimus during the treatment. Conclusions: Sirolimus has concluded as a safe alternative primary antirejection drug to calcineurin inhibitors when the side effects of these limit their application after liver transplantation.