Conversion to sirolimus in pediatric renal transplant patients: a single-center experience.

Monteverde ML, Ibanez J, Balbarrey Z, Chaparro A, Diaz M, Turconi A. Conversion to sirolimus in pediatric renal transplant patients: A single-center experience. Abstract:  We studied efficacy and safety of conversion from CNI- to SRL-based immunosuppression in 92 kidney TX recipients, mainly due to CAN (69%). Median time of conversion was 31 months (r: 0.3–165); median time of follow-up: 36 months (r: 2–102). In the whole group mean eGFR increased from 53 ± 22 to 67 ± 26 mL/min/1.73 m2 at three months (p = 0.02) and did not change subsequently. Patients with grade I CAN had higher eGFR than those with grade II CAN. Patient and graft survival was 96% and 70% 10 yr after conversion. Patients with grade I CAN had better graft survival than those with grade II CAN: 89% vs. 65% at six yr (p = 0.02) post conversion. There were two episodes of BPAR. Baseline proteinuria >20 mg/kg/day (HR: 10) and baseline eGFR 2 AEs had SRL blood levels >9 ng/mL at month 3 (p = 0.01). In conclusion, patients converted from CNI to SRL had good graft survival and tolerable but frequent AEs. Independent predictors of graft loss were baseline proteinuria and eGFR.