EXPERIENCE WITH ADDITION OF SIROLIMUS AND REDUCTION OF CALCINEURIN INHIBITORS IN PATIENTS WITH CHRONIC RENAL INSUFFICIENCY AFTER LUNG TRANSPLANTATION

P649 Aims: Until recently, there has been no practical alternative to the use of calcineurin inhibitors as primary immunosuppressants in lung transplantation. Sirolimus is a novel powerful immunosuppresant without renal toxicity, a common post-transplant problem associated with calcineurin inhibitors therapy. Methods: In 11 patients (3 with cystic fibrosis, 10 with COPD, 1 with CTEPH and 1 with PPH) the indication for lung transplantation was set. After lung transplantation these patients developed chronic kidney failure (creatinine ≥ 2mg/dl) and were switched to a combined immunosuppressive regime with reduced calcineurin inhibitors and sirolimus. The serum levels of the calcineurin inhibitors and of sirolimus should be between 5 ng/ml to 7ng/ml. We documented the values of the kidney function parameters (creatinine, BUN), lung function parameters (VC, FEV1, MEF50, TLC), number of thrombocytes, cholesterol values, triglycerid values on the day of the switch to a combined immunosuppressive regime with calcineurin inhibitors and sirolimus and three month after this switch. Results: All patients had stable lung function parameters during the observed period. There was no significant improvement of all investigated parameters in the whole patient group. According to the time between manifestation of chronic kidney failure and the switch to a combined immunosuppressive regime with calcineurin inhibitors and sirolimus we divided the patients in two groups: group A (n=5) with an early (192 ± 121.12 days) and group B (n=6) with a later (1520 ± 1151.13 days) switch. In group A there was a trend to improvement of renal function (creatinine from 2.85±0.92m/dl to 2.18±0.42mg/dl, p=0.11; BUN from 45.94±19.26mg/dl to 42.06±12.46mg/dl, p=0.69) which however was not significantly (perhaps due to the small number of patients). The number of thrombocytes changed from 251±93.57G/l to 218.25±116.59G/l, p=0.19, cholesterol values from 200.00±1.41mg/dl to 256.5±58.6mg/dl, p=0.4, the triglycerides from 201.5 ±127.99mg/dl to 338.00±52.33mg/dl, p=0.23. In group B there was no improvement of chronic renal insufficiency. Two patients died in fact of chronic kidney failure; one patient is in a dialyses program with the option of a kidney transplantation. Conclusions: This investigation suggests that the early addition of sirolimus and the reduction of the calcineurin inhibitors could be a valuable alternative immunosuppressant in patients with chronic kidney failure.