Sirolimus conversion regimen versus continued calcineurin inhibitors in liver allograft recipients: a randomized trial

Abdelmalek, M F; Humar, A; Stickel, F; Andreone, P; Pascher, A; Barroso, E; Neff, G W; Ranjan, D; Toselli, L T; Gane, E J; Scarola, J; Alberts, R G; Maller, E S; Lo, C-M; Sirolimus Liver Conversion Trial Study Group, (2012). Sirolimus conversion regimen versus continued calcineurin inhibitors in liver allograft recipients: a randomized trial. American journal of transplantation, 12(3), pp. 694-705. Oxford: Wiley-Blackwell 10.1111/j.1600-6143.2011.03919.x

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A large prospective, open-label, randomized trial evaluated conversion from calcineurin inhibitor (CNI)- to sirolimus (SRL)-based immunosuppression for preservation of renal function in liver transplantation patients. Eligible patients received liver allografts 6-144 months previously and maintenance immunosuppression with CNI (cyclosporine or tacrolimus) since early posttransplantation. In total, 607 patients were randomized (2:1) to abrupt conversion (<24 h) from CNI to SRL (n = 393) or CNI continuation for up to 6 years (n = 214). Between-group changes in baseline-adjusted mean Cockcroft-Gault GFR at month 12 (primary efficacy end point) were not significant. The primary safety end point, noninferiority of cumulative rate of graft loss or death at 12 months, was not met (6.6% vs. 5.6% in the SRL and CNI groups, respectively). Rates of death at 12 months were not significantly different, and no true graft losses (e.g. liver transplantation) were observed during the 12-month period. At 52 weeks, SRL conversion was associated with higher rates of biopsy-confirmed acute rejection (p = 0.02) and discontinuations (p < 0.001), primarily for adverse events. Adverse events were consistent with known safety profiles. In conclusion, liver transplantation patients showed no demonstrable benefit 1 year after conversion from CNI- to SRL-based immunosuppression.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology

UniBE Contributor:

Stickel, Felix

ISSN:

1600-6135

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:38

Last Modified:

17 Mar 2015 21:30

Publisher DOI:

10.1111/j.1600-6143.2011.03919.x

PubMed ID:

22233522

Web of Science ID:

000300832500026

URI:

https://boris.unibe.ch/id/eprint/15216 (FactScience: 222508)

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