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There is little evidence published regarding the efficacy and factors influencing the outcome of substitution of calcineurin inhibitors (CNIs) with other agentsas a widely accepted practice in this disorder; however, there are limited data on the options for immunosuppression manipulation (ISM). In our study, we retrospectively analyzed outcomes of 45 patients with TA\u2010TMA with ISM and substitution either with steroids (steroid group) or anmTOR inhibitor sirolimus (sirolimus group). In our study, sirolimus was associated with significantly better 1\u2010year overall survival (HR 0.3, 95% CI 0.13\u20100.7, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.004) and faster time to normalization of LDH (HR 2.2, 95% CI 0.99\u20104.99, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.044). Replacing CNIs with sirolimus could be an effective option in patients with TA\u2010TMA. A multicenter confirmatory study of CNIs replacement with sirolimus is justified.<\/jats:p>","DOI":"10.1111\/ctr.14180","type":"journal-article","created":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T09:09:07Z","timestamp":1606813747000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Conversion from calcineurin inhibitors to sirolimus in transplant\u2010associated thrombotic microangiopathy"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1460-330X","authenticated-orcid":false,"given":"Mikhail M.","family":"Kanunnikov","sequence":"first","affiliation":[{"name":"RM Gorbacheva Research Institute Pavlov University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhemal Z.","family":"Rakhmanova","sequence":"additional","affiliation":[{"name":"RM Gorbacheva Research Institute Pavlov University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita V.","family":"Levkovsky","sequence":"additional","affiliation":[{"name":"RM Gorbacheva Research Institute Pavlov University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliya I.","family":"Vafina","sequence":"additional","affiliation":[{"name":"RM Gorbacheva Research Institute Pavlov University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleg V.","family":"Goloshapov","sequence":"additional","affiliation":[{"name":"RM Gorbacheva Research Institute Pavlov University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana S.","family":"Shchegoleva","sequence":"additional","affiliation":[{"name":"RM Gorbacheva Research Institute Pavlov University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia J.","family":"Vlasova","sequence":"additional","affiliation":[{"name":"RM Gorbacheva Research Institute Pavlov University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olesya V.","family":"Paina","sequence":"additional","affiliation":[{"name":"RM Gorbacheva Research Institute Pavlov University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena V.","family":"Morozova","sequence":"additional","affiliation":[{"name":"RM Gorbacheva Research Institute Pavlov University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludmilla","family":"S. 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