TY - JOUR
T1 - Chronic Allograft Nephropathy Score Before Sirolimus Rescue Predicts Allograft Function in Renal Transplant Patients
AU - Basu, A.
AU - Falcone, J. L.
AU - Tan, H. P.
AU - Hassan, D.
AU - Dvorchik, I.
AU - Bahri, K.
AU - Thai, N.
AU - Randhawa, P. S.
AU - Marcos, A.
AU - Starzl, T. E.
AU - Shapiro, R.
PY - 2007/1
Y1 - 2007/1
N2 - Chronic allograft nephropathy (CAN) is a major indication for initiation of sirolimus (SRL) in renal transplantation (TX) to prevent deterioration of renal function. We evaluated whether the CAN score at time of sirolimus rescue (SRL-R) predicts renal allograft function. CAN score is the sum of the following 4 categories: glomerulopathy (cg, 0-3), interstitial fibrosis (ci, 0-3), tubular atrophy (ct, 0-3), and vasculopathy (cv, 0-3). This is a retrospective cohort study of renal transplant recipients from July 2001 to March 2004. Immunosuppression consisted of preconditioning with rabbit anti-thymocyte globulin or alemtuzumab and maintenance with tacrolimus (TAC) monotherapy with spaced weaning, if applicable, SRL-R was achieved by conversion from TAC, or by addition to reduced doses of TAC. Ninety patients received SRL. Thirty-three of these patients met the inclusion criteria of the following: (1) receipt of SRL for >6 months, and (2) follow-up of ≥6 months. There were 16 patients in the low-CAN (0-4) group and 17 patients in the high-CAN (>4) group. Cockcroft-Gault (C-G) glomerular filtration rate (GFR) was calculated at SRL-R and at 1, 3, 6, and 12 months. The ΔGFR was significantly better in the low-CAN group at 1, 3, and 6 months. A trend toward an improved ΔGFR was present at 12 months in the low-CAN group (P = .16). CAN scoring at the time of SRL-R predicts recovery of renal allograft function (as measured using ΔGFR), and should be used in preference to biochemical markers (Cr and C-G GFR), which may not be reliable predictors.
AB - Chronic allograft nephropathy (CAN) is a major indication for initiation of sirolimus (SRL) in renal transplantation (TX) to prevent deterioration of renal function. We evaluated whether the CAN score at time of sirolimus rescue (SRL-R) predicts renal allograft function. CAN score is the sum of the following 4 categories: glomerulopathy (cg, 0-3), interstitial fibrosis (ci, 0-3), tubular atrophy (ct, 0-3), and vasculopathy (cv, 0-3). This is a retrospective cohort study of renal transplant recipients from July 2001 to March 2004. Immunosuppression consisted of preconditioning with rabbit anti-thymocyte globulin or alemtuzumab and maintenance with tacrolimus (TAC) monotherapy with spaced weaning, if applicable, SRL-R was achieved by conversion from TAC, or by addition to reduced doses of TAC. Ninety patients received SRL. Thirty-three of these patients met the inclusion criteria of the following: (1) receipt of SRL for >6 months, and (2) follow-up of ≥6 months. There were 16 patients in the low-CAN (0-4) group and 17 patients in the high-CAN (>4) group. Cockcroft-Gault (C-G) glomerular filtration rate (GFR) was calculated at SRL-R and at 1, 3, 6, and 12 months. The ΔGFR was significantly better in the low-CAN group at 1, 3, and 6 months. A trend toward an improved ΔGFR was present at 12 months in the low-CAN group (P = .16). CAN scoring at the time of SRL-R predicts recovery of renal allograft function (as measured using ΔGFR), and should be used in preference to biochemical markers (Cr and C-G GFR), which may not be reliable predictors.
UR - http://www.scopus.com/inward/record.url?scp=33846561554&partnerID=8YFLogxK
U2 - 10.1016/j.transproceed.2006.10.017
DO - 10.1016/j.transproceed.2006.10.017
M3 - Article
C2 - 17275482
AN - SCOPUS:33846561554
SN - 0041-1345
VL - 39
SP - 94
EP - 98
JO - Transplantation Proceedings
JF - Transplantation Proceedings
IS - 1
ER -