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- W2589781687 abstract "Introduction: Allogeneic stem cell transplantation (SCT) is associated with a high incidence of acute kidney injury (AKI). Calcineurin inhibitors which form the mainstay of graft versus host disease (GvHD) prophylaxis are a major contributor to renal impairment. The optimal management of immunosuppression in patients developing renal impairment following SCT has not yet been defined. Here we describe the outcomes of eight patients who were converted to sirolimus after developing acute kidney injury while on tacrolimus. Methods: We performed a retrospective review of patients undergoing bone marrow transplantation at our institution between January 2000-September 2015 who were switched to sirolimus due to toxicities related to tacrolimus. A total of 64 patients were identified of which 8 patients were switched to sirolimus due to development of acute renal failure. Results: The baseline characteristics are shown in Table 1.Table 1Characteristics (n = 8)N (%)GenderMale4(50)Age, years (median, range)62.5(35-77)EthnicityCaucasian6(75)Asian1(12.5)Hispanic1(12.5)DiseaseAML4(50)MDS2(25)Lymphoma1(12.5)MPN1(12.5)Donor SourceMatched unrelated5(62.5)Cord Blood3(37.5)Conditioning RegimensFlu/Mel3(37.5)Flu/Bu4(50)Cy/Flu/TBI (200 cGy)1(12.5)GvHD ProphylaxisTacro/MTX5(62.5)Tacro/MMF3(37.5)Pre-Transplant Co-morbiditiesHypertension3(37.5)Diabetes Mellitus3(37.5)CKD1(12.5)Received Nephrotoxic AgentsAmphotericin1(12.5)Foscarnet5(62.5)BK Virus in Urine3(37.5) Open table in a new tab The median time to conversion to sirolimus due to renal insufficiency was 106 (79-152) days. There was a signification improvement in the mean creatinine and creatinine clearance at 1-, 3- and 6- months post conversion compared to the pre-conversion values (Table 2). None of the patients required dialysis.Table 2Renal Function (as Assessed by Creatinine and Creatinine Clearance) at 1-, 3- and 6-Month Post Sirolimus ConversionTime of TransplantPre-conversion to Sirolimus1-month Post ConversionP value3-months Post SwitchP value6-months Post ConversionP valueMean Creatinine (mg/dL).911.781.24.011.36.011.23.024Mean Creatinine Clearance (ml/min/1.73 m2)893650.0149.00257.042 Open table in a new tab At median follow up of 261 (135-517) days post-transplant 7 of 8 patients developed Grade I-II acute GvHD (Figure 1). No patients developed grade III-IV acute GvHD. Two of the seven evaluable patients developed chronic GvHD. Conclusion: Conversion to sirolimus is associated with improved renal function in patients developing AKI while on tacrolimus. Longer follow up is needed to determine the impact of sirolimus conversion on the cumulative incidence of GvHD. There is a need for prospective studies to address the feasibility of calcineurin-free GvHD prophylaxis in SCT." @default.
- W2589781687 created "2017-03-03" @default.
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- W2589781687 date "2017-03-01" @default.
- W2589781687 modified "2023-10-18" @default.
- W2589781687 title "Improved Renal Outcomes in Patients Converted From Tacrolimus to Sirolimus after Developing Acute Kidney Injury Post Allogeneic Stem Cell Transplantation" @default.
- W2589781687 doi "https://doi.org/10.1016/j.bbmt.2016.12.209" @default.
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