{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T09:08:04Z","timestamp":1761988084423},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2006,5,17]],"date-time":"2006-05-17T00:00:00Z","timestamp":1147824000000},"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":[[2006,8]]},"abstract":"<jats:p><jats:bold>Abstract:\u2002<\/jats:bold> CAN is a major cause for allograft loss in renal transplantation. Sirolimus was recently introduced as a potent non\u2010nephrotoxic alternative to CNIs. In the present study, effects of a conversion protocol were investigated in pediatric CAN with declining GFR, defined by a Schwartz formula clearance below 60\u2003mL\/1.73\u2003m<jats:sup>2<\/jats:sup>\/min, steadily increasing SCr and allograft biopsy. In eight children with a median age of 12.8\u2003yr, sirolimus was started at median 32\u2003months after transplantation with a loading dose of 0.24\u2003mg\/kgBW, followed by 0.2\u2003mg\/kgBW\/day, aimed at trough levels of 15\u201320\u2003ng\/mL. CNIs were reduced to 50% at start of sirolimus and discontinued at median seven\u2003days 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 of eight patients (p\u2003=\u20030.026), only one child exhibited unaltered progression of graft failure. In the responders, mean SCr improved by 0.3\u2003mg\/dL (p\u2003=\u20030.043). Effects were not dependent on GFR at conversion, nor time post\u2010transplantation. Blood pressure, hematological parameters and proteinuria remained stable during the observation period, serum lipids transiently increased. 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 CNIs 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 proven CAN.<\/jats:p>","DOI":"10.1111\/j.1399-3046.2006.00515.x","type":"journal-article","created":{"date-parts":[[2006,5,17]],"date-time":"2006-05-17T08:46:22Z","timestamp":1147855582000},"page":"565-569","source":"Crossref","is-referenced-by-count":17,"title":["Conversion from calcineurin inhibitor to sirolimus in pediatric chronic allograft nephropathy"],"prefix":"10.1111","volume":"10","author":[{"given":"Jutta 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