{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:45:05Z","timestamp":1791823505584,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2006,5,2]],"date-time":"2006-05-02T00:00:00Z","timestamp":1146528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2006,6]]},"abstract":"<jats:p><jats:bold>Abstract:\u2002<\/jats:bold> Chronic allograft nephropathy is a major cause for allograft loss in renal transplantation. Sirolimus was recently introduced as a potent non\u2010nephrotoxic alternative to calcineurin inhibitors. In the present study, effects of a conversion protocol were investigated in pediatric chronic allograft nephropathy with declining glomerular filtration rate (GFR), defined by a Schwartz formula clearance below 60\u2003mL\/1.73\u2003m<jats:sup>2<\/jats:sup>\/min, steadily increasing serum creatinine and allograft biopsy. In eight children with a median age of 12.8\u2003yr, sirolimus was started at median 32 months after transplantation with a loading dose of 0.24\u2003mg\/kg bodyweight (BW), followed by 0.2\u2003mg\/kgBW\/day, aimed at trough levels of 15\u201320\u2003ng\/mL. Calcineurin inhibitors were reduced to 50% at the start of sirolimus and discontinued at median 7 days when target levels of sirolimus were reached. Following conversion, changes of GFR significantly stabilized (\u22122.9 vs. +0.4\u2003mL\/min\/1.73\u2003m<jats:sup>2<\/jats:sup>\/month, p\u2003=\u20030.025). Individual GFR increased in five out of eight patients (p\u2003=\u20030.026), and only one child exhibited unaltered progression of graft failure. In the responders, mean serum creatinine improved by 0.3\u2003mg\/dL (p\u2003=\u20030.043). Effects were not dependent on GFR at conversion, or on time post\u2010transplantation. Blood pressure, hematological parameters and proteinuria remained stable during the observation period, and serum lipids increased transiently. About half of the children suffered from infectious complications. No child had to be taken off sirolimus; there was no graft loss during the observation period. In conclusion, conversion from calcineurin inhibitors to sirolimus is an effective protocol with tolerable side effects to stabilize renal graft function for at least one\u2003yr in the majority of children with biopsy\u2010proven chronic allograft nephropathy.<\/jats:p>","DOI":"10.1111\/j.1399-3046.2006.00503.x","type":"journal-article","created":{"date-parts":[[2006,5,3]],"date-time":"2006-05-03T04:41:02Z","timestamp":1146631262000},"page":"474-478","source":"Crossref","is-referenced-by-count":14,"title":["Conversion from calcineurin inhibitor to sirolimus in pediatric chronic allograft nephropathy"],"prefix":"10.1111","volume":"10","author":[{"given":"Jutta C.","family":"Falger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Arbeiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Boehm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz","family":"Regele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egon","family":"Balzar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Aufricht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,5,19]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2004.00332.x"},{"key":"e_1_2_5_3_2","first-page":"1736","article-title":"Histopathologic findings from 2\u2010year protocol biopsies from a U.S. multicenter kidney transplant trial comparing tarolimus versus cyclosporine","volume":"66","author":"Solez K","year":"1998","journal-title":"a report of the FK506 Kidney Transplant Study Group"},{"key":"e_1_2_5_4_2","first-page":"142","article-title":"Reduction in acute rejections decreases chronic rejection graft failure in children","volume":"2","author":"Tejani A","year":"2002","journal-title":"a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3046.1999.00036.x"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2001.27838"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2005.00305.x"},{"key":"e_1_2_5_8_2","first-page":"1748","article-title":"Calcineurin inhibitor withdrawal from sirolimus\u2010based therapy in kidney transplantation","volume":"5","author":"Mulay AV","year":"2005","journal-title":"a systematic review of randomized trials"},{"key":"e_1_2_5_9_2","first-page":"1244","article-title":"Conversion to rapamycin immunosuppression in renal transplant recipients","volume":"70","author":"Dominguez J","year":"2000","journal-title":"report of an initial experience"},{"key":"e_1_2_5_10_2","first-page":"131S","article-title":"Conversion to sirolimus in solid organ transplantation","volume":"35","author":"Egidi MF","year":"2003","journal-title":"a single-center experience"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-1345(03)00375-0"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2004.00590.x"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2004.08.005"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2005.00329.x"},{"key":"e_1_2_5_15_2","first-page":"151","article-title":"Rapamycin rescue therapy in patients after kidney transplantation","volume":"18","author":"Weber T","year":"2005","journal-title":"first clinical experience"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.01055.x"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfh957"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2005.00360.x"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-1345(03)00055-1"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2004.12.242"},{"key":"e_1_2_5_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-004-1733-4"},{"key":"e_1_2_5_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000140868.88149.63"},{"key":"e_1_2_5_23_2","first-page":"466","article-title":"Mycophenolate mofetil creeping creatinine study group. 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