Absence of Proteinuria Predicts Improvement in Renal Function After Conversion to Sirolimus-based Immunosuppressive Regimens in Lung Transplant Survivors With Chronic Kidney Disease

• Published in: The Journal of heart and lung transplantation Vol. 28; no. 6; pp. 564 - 571
• Main Authors: Stephany, Brian R., MD, Boumitri, Mirna, MD, Budev, Marie, DO, MPH, Alao, Bashar, MD, Poggio, Emilio D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2009; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Calcineurin Inhibitors; Cardiology. Vascular system; Chronic Disease; Cohort Studies; Female; Glomerular Filtration Rate - physiology; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Kidney - physiopathology; Kidney Diseases - complications; Kidney Diseases - physiopathology; Kidneys; Lung Transplantation - immunology; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Predictive Value of Tests; Proteinuria - diagnosis; Proteinuria - etiology; Proteinuria - prevention & control; Retrospective Studies; Sirolimus - adverse effects; Sirolimus - therapeutic use; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Antineoplastic agent; Graft(material); Renal function; Sirolimus; Lung; Transplantation; Homotransplantation; Phlebology; Macrocycle; Improvement; Surgery; Graft; Protein synthesis inhibitor; Cardiology; Kidney disease; Drug combination; Urinary system disease; Survivor; Prediction; Lactone; Chronic kidney disease; Macrolide; Conversion; Recommendation; Drug conversion; Antibiotic; Treatment; Renal failure; Application method; Circulatory system; Immunosuppressive agent; Therapeutic protocol; Proteinuria
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2009.03.010

Background Improvement in renal function has been noted in some lung allograft recipients with chronic kidney disease (CKD) converted from a calcineurin inhibitor (CNI)- to a sirolimus (SRL)-based immunosuppressive regimen. However, not all patients have such a positive response. We sought to investigate independent predictors of a favorable renal response in a cohort of lung transplant recipients. Methods We retrospectively studied 56 lung transplant recipients with CKD, defined as a pre-conversion estimated glomerular filtration rate (eGFR) ≤60 ml/min/1.73 m2 , who had been converted to CNI-sparing regimens using SRL (CNI-free: n = 10; CNI dose reduction + SRL: n = 46). Proteinuria prior to conversion, defined as ≥1+ on urine dipstick, was determined when available ( n = 51). Changes in mean eGFR post-conversion and independent predictors of a favorable renal response, defined as a rise in eGFR ≥20% within 1 month, were investigated. Results Mean eGFR at conversion was 35 ± 14 ml/min/1.73 m2 , increasing by 8 ± 14 ml/min/1.73 m2 ( p < 0.01) by 1 month post-conversion, a trend that remained significant out to 18 months. A total of 43% ( n = 24) of patients had a rise in eGFR ≥20%. Forced expiratory volume in 1 second (FEV1 ) remained stable in survivors maintained on SRL and only 1 rejection episode occurred. When controlling for gender, age, pre-conversion eGFR and CNI-free vs CNI-dose reduction, the only variable that remained independently predictive of a favorable renal response was absence of proteinuria, with an odds ratio = 3.3 (95% confidence interval 1.0 to 12.5, p = 0.05). Conclusions Non-proteinuric lung transplant survivors with CKD are more likely to respond favorably from a renal standpoint after conversion to SRL with CNI-dose reduction or elimination.