Published data are limited describing renal outcomes in orthotopic liver transplant (OLT) recipients prescribed de novo sirolimus (SRL) maintenance immunosuppression and rabbit antithymocyte globulin (rATG). This is a retrospective chart review of 618 consecutive OLTs performed between 2006 and 2011. All patients received rATG induction with steroid avoidance and maintenance immunosuppression consisted of SRL or tacrolimus (TAC) with mycophenolate mofetil. De novo SRL was defined as SRL initiated by postoperative day 30. Pretransplant renal dysfunction was defined as serum creatinine > 1.5 on the day of transplant. Estimated glomerular filtration rate (eGFR) was calculated with the abbreviated MDRD (Modification of Diet in Renal Disease) equation. Of the 618 patients screened, 93 patients met the inclusion criteria. Of the 93 patients included: 54 (58%) received TAC and 39 (42%) received SRL for a median of 722 and 715 days, respectively. The median pretransplant serum creatinine was 1.9 mg/dl for both groups. Baseline demographics were similar between groups. An higher incidence of renal replacement therapy during the initial hospitalization occurred in the SRL group (28% vs. 0%; P < 0.05). The eGFR in the TAC group was higher at every time point, but only significant at months 1 and 6 (P<0.05). However, improvement in eGFR was noted in the SRL group from the day of maintenance immunosuppression initiation to 1, 2, 3, 6, 12, and 24 months postoperatively (P<0.05). No differences in graft survival, patient survival, biopsy-proven acute cellular rejection, and progression to renal replacement therapy after the initial hospitalization were identified. Patients with pretransplant renal dysfunction prescribed rATG and de novo SRL may benefit with a preserved or improved eGFR.

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