Impact of tacrolimus-sirolimus maintenance immunosuppression on proteinuria and kidney function in pancreas transplant alone recipients

Praveen Kandula, Jonathan Fridell, Tim E. Taber, Asif Sharfuddin, Muhammad S. Yaqub, Carrie L. Phillips, Jeannie Chen, Muhammad Mujtaba

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: Nephrotoxicity is a major complication with immunosuppression regimens used in transplantation. Calcineurin inhibitor-sparing or reduction regimens using sirolimus (SRL) have shown variable success in kidney transplantation. There is limited data on the role of SRL on native kidney function in pancreas transplantation. METHODS: All patients undergoing pancreas transplantation from 2003 to 2010 were enrolled in this study (n=65). Patient demographic characteristics were identified and divided into two groups: those receiving tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and those maintained on a regimen of Tac and SRL with or without MMF. The slopes for estimated glomerular filtration rate (eGFR), serum creatinine level (sCr), and proteinuria changes over time were assessed between groups. Urine protein and creatinine ratio (uPr/uCr) was used to assess proteinuria. RESULTS: There was no difference in baseline demographic characteristics. Patients were followed for a median of 3 years. Baseline sCr and eGFR were similar between groups. Differences in uPr/uCr and rate of change in sCr and eGFR were not significant between the groups overall or for any specific time. There was worsening of sCr, eGFR, and uPr/uCr within the groups over the period of study. There were no significant differences when groups were split by age or gender or when the SRL group was split further based on MMF inclusion. CONCLUSIONS: Our study findings suggest that using a Tac-SRL regimen in patients with pancreas alone transplantation is a safe approach and may not lead to worsening proteinuria and kidney function when compared with regimens using Tac with MMF.

Original languageEnglish (US)
Pages (from-to)940-946
Number of pages7
JournalTransplantation
Volume94
Issue number9
DOIs
StatePublished - Nov 15 2012
Externally publishedYes

Fingerprint

Mycophenolic Acid
Tacrolimus
Sirolimus
Proteinuria
Immunosuppression
Pancreas
Creatinine
Glomerular Filtration Rate
Pancreas Transplantation
Maintenance
Kidney
Serum
Demography
Kidney Transplantation
Transplantation
Transplant Recipients
Urine
Proteins

Keywords

  • Pancreas transplantation
  • Proteinuria
  • Sirolimus
  • Tacrolimus

ASJC Scopus subject areas

  • Transplantation

Cite this

Impact of tacrolimus-sirolimus maintenance immunosuppression on proteinuria and kidney function in pancreas transplant alone recipients. / Kandula, Praveen; Fridell, Jonathan; Taber, Tim E.; Sharfuddin, Asif; Yaqub, Muhammad S.; Phillips, Carrie L.; Chen, Jeannie; Mujtaba, Muhammad.

In: Transplantation, Vol. 94, No. 9, 15.11.2012, p. 940-946.

Research output: Contribution to journalArticle

Kandula, Praveen ; Fridell, Jonathan ; Taber, Tim E. ; Sharfuddin, Asif ; Yaqub, Muhammad S. ; Phillips, Carrie L. ; Chen, Jeannie ; Mujtaba, Muhammad. / Impact of tacrolimus-sirolimus maintenance immunosuppression on proteinuria and kidney function in pancreas transplant alone recipients. In: Transplantation. 2012 ; Vol. 94, No. 9. pp. 940-946.
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AU - Kandula, Praveen

AU - Fridell, Jonathan

AU - Taber, Tim E.

AU - Sharfuddin, Asif

AU - Yaqub, Muhammad S.

AU - Phillips, Carrie L.

AU - Chen, Jeannie

AU - Mujtaba, Muhammad

PY - 2012/11/15

Y1 - 2012/11/15

N2 - BACKGROUND: Nephrotoxicity is a major complication with immunosuppression regimens used in transplantation. Calcineurin inhibitor-sparing or reduction regimens using sirolimus (SRL) have shown variable success in kidney transplantation. There is limited data on the role of SRL on native kidney function in pancreas transplantation. METHODS: All patients undergoing pancreas transplantation from 2003 to 2010 were enrolled in this study (n=65). Patient demographic characteristics were identified and divided into two groups: those receiving tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and those maintained on a regimen of Tac and SRL with or without MMF. The slopes for estimated glomerular filtration rate (eGFR), serum creatinine level (sCr), and proteinuria changes over time were assessed between groups. Urine protein and creatinine ratio (uPr/uCr) was used to assess proteinuria. RESULTS: There was no difference in baseline demographic characteristics. Patients were followed for a median of 3 years. Baseline sCr and eGFR were similar between groups. Differences in uPr/uCr and rate of change in sCr and eGFR were not significant between the groups overall or for any specific time. There was worsening of sCr, eGFR, and uPr/uCr within the groups over the period of study. There were no significant differences when groups were split by age or gender or when the SRL group was split further based on MMF inclusion. CONCLUSIONS: Our study findings suggest that using a Tac-SRL regimen in patients with pancreas alone transplantation is a safe approach and may not lead to worsening proteinuria and kidney function when compared with regimens using Tac with MMF.

AB - BACKGROUND: Nephrotoxicity is a major complication with immunosuppression regimens used in transplantation. Calcineurin inhibitor-sparing or reduction regimens using sirolimus (SRL) have shown variable success in kidney transplantation. There is limited data on the role of SRL on native kidney function in pancreas transplantation. METHODS: All patients undergoing pancreas transplantation from 2003 to 2010 were enrolled in this study (n=65). Patient demographic characteristics were identified and divided into two groups: those receiving tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and those maintained on a regimen of Tac and SRL with or without MMF. The slopes for estimated glomerular filtration rate (eGFR), serum creatinine level (sCr), and proteinuria changes over time were assessed between groups. Urine protein and creatinine ratio (uPr/uCr) was used to assess proteinuria. RESULTS: There was no difference in baseline demographic characteristics. Patients were followed for a median of 3 years. Baseline sCr and eGFR were similar between groups. Differences in uPr/uCr and rate of change in sCr and eGFR were not significant between the groups overall or for any specific time. There was worsening of sCr, eGFR, and uPr/uCr within the groups over the period of study. There were no significant differences when groups were split by age or gender or when the SRL group was split further based on MMF inclusion. CONCLUSIONS: Our study findings suggest that using a Tac-SRL regimen in patients with pancreas alone transplantation is a safe approach and may not lead to worsening proteinuria and kidney function when compared with regimens using Tac with MMF.

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