CONVERSION TO RAPAMYCIN IMMUNOSUPPRESSION IN RENAL TRANSPLANT RECIPIENTS: REPORT OF AN INITIAL EXPERIENCE1

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Abstract
The aim of thisstudy is to evaluate the effects of RAPA conversion in patients undergoing cyclosporine (CsA) or tacrolimus (Tac) toxicity. Twenty renal transplant recipients were switched to fixed dose rapamycin (RAPA) (5 mg/day) 0 to 204 months posttransplant. Drug monitoring was not initially used to adjust doses. The indications for switch were chronic CsA or Tac nephrotoxicity (12), acute CsA or Tac toxicity (3), severe facial dysmorphism (2), posttransplant lymphoproliferative disorder (PTLD) in remission (2), and hepatotoxicity in 1. Follow-up is 7 to 24 months. In the 12 patients switched because of chronic nephrotoxicity there was a significant decrease in serum creatinine [233±34 to 210±56 μmol/liter (P 15 ng/ml) in 7 of 13 (54%) patients. RAPA conversion provides adequate immunosuppression to enable CsA withdrawal. However, when converting patients to RAPA drug levels should be monitored to avoid over-immunosuppression and adequate antiviral and Pneumocystis carinii pneumonia prophylaxis should be given.