Influence of immunosuppressive regimen change on renal function in liver transplant recipiens

Background. Liver transplantation is accepted treatment of choice for many liver diseases. Long-term survival is limited by toxicity of immunosuppresive agents, sub-clinical as well as cronic rejection. Newer classes of immunosuppresive agents, including calcineurin inhibitors CNI (cyclosporine and tacrolimus) and mammalian target of rapamycin (mTOR) inhibitors (sirolimus and everolimus) have potential to improve long-term outcomes. Many long-term survivors face a considerable risk of renal dysfunction due to CNI. The aim of the study was to detrmine benefits of sirolimus compared to CNI towards kidneys toxicity. Materials and methods. We have monitored nine orthotopic liver transplantation patients (OLT) who underwent conversion of immunosuppresive regiment from CNIs to sirolimus. Creatinine concentrations were measured with the creatinine enzymatic assay. Measured concentrations of serum creatinine were used to estimate renal function, after dosing CNIs and converting to sirolimus, each one, three and six months after the dose. Results. Reffering to the long-term outcomes of OLT patients following results could be seen: among all patients switched to sirolimus, the levels of serum creatinine (80, 3 umol/L+/-12, 8 vs. 76, 0 umol/L+/-12, 7) remained stable in three of them, whereas the levels of serum creatinine started to decrease (119, 4 umol/L+/- 29, 8 vs. 83, 2 umol/L+/- 26, 3) after administration of sirolimus in six of the patients. Conclusion. These preliminary results have shown that sirolimus is effective in preventing rejection in OLT recipients and it is associated with improved renal function. mTOR inhibitors might have a role as an early alternative to CNIs in patients with CNI nephrotoxicity.