Abstract:

BACKGROUND: Sirolimus has been proposed as a non-nephrotoxic alternative to calcineurin inhibitor for prevention of adverse reaction after kidney transplantation, proteinuria is one of the most significant adverse reactions. So far, there is no effective treatment measure, and it limits the use of this molecule.
OBJECTIVE: To investigate the efficacy and safety of low-dose cyclosporine A in reducing the sirolimus-associated proteinuria after kidney transplantation.
METHODS: This prospective study included 24 kidney transplant recipients who receiving sirolimus based tri-regimens immunosuppressed therapy (sirolimus+mycophenolate mofetil+cotical hormone) and suffering sirolimus-associated proteinuria. Low-dose cyclosporine (25 mg/d) was added to the tri-regimens immunosuppression in 10 recipients (tetra-regimens group), and the other 14 patients maintained the tri-regimens immonusuppression (tri-regimens group). All the patients were followed-up for 6 months.
RESULTS AND CONCLUSION: ①After 6 months follow-up, the content of proteinuria in the tetra-regimens group was significantly decreased (P < 0.01), and the difference was significant when compared with tri-regimens group (P < 0.05). ②There was no significant difference of the glomerular filtration rate between two groups (P=0.10). There were three patients suffering from genitourinary tract infection in tri-regimens group, while three patients in tetra-regimens group suffered from six infectious episodes, one patient suffered from lung infection and five patients suffered from genitourinary tract infection. Low-dose cyclosporine can reduce sirolimus-associated proteinuria after kidney transplantation without serious nephrotoxicity and infectious side effects.