New Onset Proteinuria after Conversion to Sirolimus in Renal Transplantation
Med. Klinik M. S. Nephrology, Charité
Universitätsmedizin, Berlin, Germany
Med. Klinik I - Nephrology, Klinikum Merheim, Köln, Germany
Hospital Clinic, Villarroel, Barcelona, Spain
Nephrology, University Hospital RWTH, Aachen, Germany
Nephrologie, LMU, München, Germany
Nephrology, University Hospital, Frankfurt, Germany
Nephrology, Medizinische Hochschule, Hannover, Germany
Nephrology, University Hospital, Tübingen, Germany
Med. Klinik Nephrologie und Intern. Internsivmed., Charité
Universitätsmedizin, Berlin, Germany
Nephrology, University Hospital, Heidelberg, Germany
Nephrology, University Hospital, Erlangen, Germany
Pfizer Pharma GmbH, Berlin, Germany
Meeting: 2013 American Transplant Congress
Abstract number: B938
To avoid nephrotoxicity calcineurin inhibitors are frequently replaced by mTOR-inhibitors like Sirolimus (SRL). Worsening of proteinuria has been reported after conversion to mTOR-inhibitors. We aimed to assess frequency, extent and risk factors for new onset proteinuria (NOP) after conversion to SRL in a large multi center cohort.
For this retrospective analysis 10 German transplant centers collected demographic, transplant and laboratory data of all renal allograft recipients (pts) being converted to SRL between Jan 1st 2000 to Dec 31st 2008. All pts were converted to a SRL containing immunosuppression at least 90 days after transplantation (Tx). NOP was defined as urine protein concentration >500mg/l detected postconversion in pts <500mg/l preconversion. A cut off value was defined using ROC-curve analysis.
In 332 pts (69.0% male, 44.9±14 years at Tx and 5.8 ± 6.1 years post Tx) had no relevant proteinuria preconversion. In 90 pts (27.1%) NOP developed, mostly (n=57, 19.2%) within 6 months postconversion. Already at conversion pts with NOP had a significant higher urinary protein concentration (80mg/l vs. 150mg/l, p<0.005). We found that proteinuria >78 mg/l at conversion was associated with NOP (p<0.005) with an auc of 0.73, p<0.005. 24/90 pts (26.6%) developed severe proteinuria (>1500mg/l). In 115/332 pts (34.6%) SRL was stopped. The 5-year-graft-survival rate was lower in pts with NOP (74.1% vs. 84.1%, p=0.031). Patient survival was equal however. Creatinine at conversion, time from tx to conversion, sex, and year of conversion were no risk factors for NOP.
The conversion of pts with proteinuria <78 mg/l resulted in excellent long-term outcomes with a low risk of NOP. Conversion of pts with higher proteinuria should be done cautiously under close surveillance of urinary protein excretion.
Naik, M.: Grant/Research Support, Advisory Board Member. Riester, U.: Employee, Pfizer.
To cite this abstract in AMA style:
Naik M, Arns W, Budde K, Diekmann F, Eitner F, Fischereder M, Goßmann J, Gwinner W, Heyne N, Jürgensen J, Morath C, Pressmar K, Riester U. New Onset Proteinuria after Conversion to Sirolimus in Renal Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/new-onset-proteinuria-after-conversion-to-sirolimus-in-renal-transplantation/. Accessed November 23, 2024.« Back to 2013 American Transplant Congress