Aims:

To identifiy predictors of successful conversion from CNI to SRL for chronic allograft dysfunction (CAD) we investigated 59 renal transplant patients with CAD without histological signs of acute rejection.

Methods:

These received 15 mg SRL once, then 5 mg/day, target trough level 8-12 ng/ml. CNI dose was reduced by 50% simultaneously, and withdrawn over 1-2 months. Concomittant immunosuppression remained unchanged. Univariate and multivariate analyses were performed.

Results:

After one year patient survival was 100%, graft survival 92%. In responders (54%) creatinine improved (2.76±0.14 mg/dL to 2.22±0.13 mg/dL; p< 0.01). In non-responders (46%) creatinine deteriorated (3.23±0.21 mg/dL to 4.43±0.34 mg/dL; p< 0.01). Baseline renal function did not differ, however, baseline proteinuria (responders 519±116 mg/day vs. non-responders 1532±185 mg/day, p< 0.01), histological grade of CAN (1.2±0.5 in responders vs. 1.9±0.6 in non-responders; p< 0.01), number of acute rejections before conversion (0.73±0.69 in responders vs. 1.27±0.96 in non-responders; p< 0.05), differed significantly between responders and non-responders. In a multivariate analysis proteinuria below 800 mg/d was the only independent variable with a positive predictive value of 89.2%.

Conclusions:

Proteinuria at conversion below 800 mg/d is the only independent predictor for positive outcome in conversion from CNI to SRL in chronic allograft dysfunction.