Korean J Transplant.  2023 Nov;37(Suppl 1):S227. 10.4285/ATW2023.F-8149.

Long-term clinical outcomes of late conversion to once-daily tacrolimus and sirolimus combination in stable kidney transplant recipients

• Oh YJ
• Jung CW
• Jun H
• Kim MG
• Park JH

• KMID: 2551847
• DOI: http://doi.org/10.4285/ATW2023.F-8149

Abstract

Background
The use of calcineurin inhibitors (CNIs) has significantly improved graft outcomes in kidney transplantation (KT); however, nephrotoxicity resulting from their prolonged use presents a significant clinical concern that must not be overlooked. Although CNIs minimization combined with mammalian target of rapamycin (mTOR) inhibitors has been introduced to reduce nephrotoxic effects from CNIs, apprehensions regarding under-immunosuppression remain prevalent. This study aimed to evaluated the long-term clinical outcomes of late conversion to once-daily tacrolimus and sirolimus regimen in stable KT recipients.
Methods
We conducted a retrospective review of 35 patients who underwent conversion from twice-daily tacrolimus and MMF to a once-daily combination of tacrolimus and sirolimus, along with 35 non-conversion patients, at Korea University Anam Hospital from January 2009 to December 2012, covering a span of 10 years and including laboratory findings.
Results
Donors and recipients characteristics were similar between two group. There was somewhat better serum creatinine levels and estimated glomerular filtration rate over the course of a decade in the conversion group with no statistical significance. The incidence of biopsy-proven acute rejections and infections were not significantly different between two groups. The reconversion rate to the original regimen, due to various reasons such as proteinuria, oral ulcer, etc. was quite high at 34.3%.
Conclusions
Based on the long-term clinical outcomes, a once-daily tacrolimus and sirolimus combination could be considered as an attractive alternative to the conventional regimen with the expectation better renal functions, despite a high reconversion rate due to various reluctant reasons.