Improved renal function in de novo renal transplant patients on sirolimus maintenance therapy following discontinuation of cyclosporine.

In the presirolimus era, cyclosporine withdrawal in de novo renal transplant patients was associated with increased rates of rejections; thus, no improvement in long-term graft survival was achieved. However, those patients who did not reject exhibited longer graft survival than did those on cyclosporine. In recent years sirolimus has been introduced into clinical practice and, so far, 4 randomized cyclosporine withdrawal trials in de novo patients after renal transplantation have been published, together with 3 smaller studies directly comparing cyclosporine with sirolimus. The main finding in all these studies was better renal function after cyclosporine withdrawal. In the largest trial with the longest follow-up there was even a trend toward higher rates of graft survival at 3 years and fewer histopathological findings in protocol biopsies at that time. Whether this success in renal function and graft survival will project to prolonged patient survival remains to be determined. In summary, with the introduction of sirolimus as a potent immunosuppressive but nonnephrotoxic drug, a considerable improvement in graft and patient survival might be possible.