Early conversion from calcineurin inhibitors to sirolimus in liver transplant patients with renal dysfunction: A systemic and splanchnic hemodynamic study.

Aims: It has been demonstrated that sirolimus, a potent immnunosuppressant agent, allowing a reduction of nephrotoxic effects of CNIs.  We have evaluated whether conversion from a CNIs to sirolimus reduces nephrotoxicity in liver transplant recipients. We have also investigated whether this effect is accompanied to systemic, splanchnic and renal hemodynamic changes. Material and methods: Twelve patients with a suboptimal renal function, defined as an estimated glomerular filtration rate (GFR) of less than 50 ml/min, were included. Hemodynamic parameters were measured by doppler. Both measurements were performed in baseline (pre conversion to sirolimus) and 30 and 90 days after sirolimus . Results: The target range for whole blood sirolimus concentration was between 5 and 12 mg/ml. There was a significant difference in GFR at 30 (57 ± 20 ml/min) and 90 (58 ± 21 ml/min) days in patients switching to sirolimus compared to those observed during the administration of CNIs (39 ± 9 ml/min, p<0.05).  This effect on renal hemodynamic is accompanied by a significant reduction in mean arterial pressure. No significant changes were observed in the other parameters studied. Conclusion: Our results suggest that early withdrawal of CNIs is a safe option, which allows an improvement in renal hemodynamic in liver transplant recipients.