, Volume 68, Supplement 1, pp 41–49 | Cite as

Sirolimus Use in Recipients of Expanded Criteria Donor Kidneys

  • Andrew A. House
  • Christopher Y. Nguan
  • Patrick P. Luke
Review Article


With changing donor characteristics and the growing shortage in organ supply, renal transplant practitioners have sought to optimize the use of expanded criteria donor (ECD) kidneys, which have poorer outcomes than standard criteria donor (SCD) kidneys. The outcomes may represent an acceptable trade-off if ECD transplants offer enhanced overall patient survival by reducing waiting times. ECD kidneys may be more susceptible to toxicity associated with calcineurin inhibitors (CNIs); therefore, a potential strategy to improve outcomes in this growing demographic is the use of CNI-free immunosuppressive protocols. To date, published clinical studies have demonstrated encouraging outcomes using sirolimus-based CNI-free regimens in SCD kidney transplant recipients. We conducted a pilot study to examine outcomes in ECD kidney transplant recipients receiving a CNI-free quadruple drug regimen, consisting of antithymocyte globulin (ATG), sirolimus, mycophenolate mofetil (MMF) and a corticosteroid, compared with outcomes in a retrospective CNI-control group of ECD recipients who had received standard CNI-based immunosuppressive treatment. Patient survival and allograft survival at 1 year were not significantly different between the CNI-free group (n = 13) and the CNI-control group (n = 13) [100% vs 92% and 92% vs 85%, respectively]; nor was the incidence of rejection (26% and 31%) or delayed graft function (38% of patients in both groups). Serum creatinine was significantly lower and the estimated glomerular filtration rate was significantly higher for the CNI-free group at 3–6 months but not at 1 year. Protocol biopsies in the CNI-free patients at 1 year revealed no significant progression of chronic vascular lesions. Banff chronic/sclerosing allograft nephropathy scores were 42% grade I, 25% grades II and III, and 33% grade 0. Thus, a sirolimus-based CNI-free regimen may improve outcomes in ECD kidney transplant recipients and merits further study.


Sirolimus Deceased Donor Basiliximab Delay Graft Function Chronic Allograft Nephropathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to thank Dr Cathryn Jarvis, Dr Isabella Steffensen and Science & Medicine Canada for their editorial assistance in preparing this review. This work was supported by an unrestricted educational grant from Wyeth Canada. The study was funded through an Investigator Originated Proposal Grant from Wyeth-Ayerst Canada Inc.; however, the data were collected and analysed by the investigators without involvement of the sponsor. Dr House and Dr Nguan have received honoraria from Wyeth for CME presentations. Dr Luke reports no conflicts of interest.


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Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Andrew A. House
    • 1
    • 2
    • 3
  • Christopher Y. Nguan
    • 4
  • Patrick P. Luke
    • 1
    • 3
    • 5
  1. 1.University of Western Ontario Faculty of MedicineLondonCanada
  2. 2.Division of Nephrology, London Health Sciences CentreUniversity Hospital, OntarioLondonCanada
  3. 3.Multiorgan Transplant ProgramLondonCanada
  4. 4.Department of Urological Sciences, Vancouver General HospitalUniversity of British ColumbiaVancouverCanada
  5. 5.Division of Urology, London Health Sciences CentreUniversity HospitalLondonCanada

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