{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T14:23:26Z","timestamp":1768832606214,"version":"3.49.0"},"reference-count":0,"publisher":"National Library of Serbia","issue":"9","license":[{"start":{"date-parts":[[2013,1,1]],"date-time":"2013-01-01T00:00:00Z","timestamp":1356998400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["VSP","VOJNOSANIT PREGL","VOJNOSANITETSKI PREG"],"published-print":{"date-parts":[[2013]]},"abstract":"<jats:p>Background\/Aim. Tremendous breakthrough in solid organ transplantation was\n   made with the introduction of calcineurin inhibitors (CNI). At the same\n   time, they are potentially nephrotoxic drugs with influence on onset and\n   progression of renal graft failure. The aim of this study was to evaluate\n   the outcome of a conversion from CNIbased immunosuppressive protocol to\n   sirolimus (SRL) in recipients with graft in chronic kidney disease (CKD)\n   grade III and proteinuria below 500 mg\/day. Methods. In the period 2003-2011\n   24 patients (6 famale and 18 male), mean age 41 ? 12.2 years, on triple\n   immunosuppressive therapy: steroids, antiproliferative drug [mycophenolate\n   mofetil (MMF) or azathiopirine (AZA)] and CNI were switched from CNI to SRL\n   and followe-up for 76 ? 13 months. Nine patients (the group I) had early\n   postransplant conversion after 4 ? 3 months and 15 patients (the group II)\n   late conversion after 46 ? 29 months. During the regular outpatient controls\n   we followed graft function through the serum creatinine and glomerular\n   filtration rate (GFR), proteinuria, lipidemia and side effects. Results.\n   Thirty days after conversion, in all the patients GFR, proteinuria and\n   lipidemia were insignificantly increased. In the first two post-conversion\n   months all the patients had at least one urinary or respiratory infection,\n   and 10 patients reactivated cytomegalovirus (CMV) infection or disease, and\n   they were successfully treated with standard therapy. After 21 ? 11 months\n   15 patients from both groups discontinued SRL therapy due to reconversion to\n   CNI (10 patients) and double immunosuppressive therapy (3 patients), return\n   to hemodialysis (1 patient) and death (1 patient). Nine patients were still\n   on SRL therapy. By the end of the follow-up they significantly improved GFR\n   (from 53.2 ? 12.7 to 69 ? 15 mL\/min), while the increase in proteinuria\n   (from 265 ? 239 to 530.6 ? 416.7 mg\/day) and lipidemia (cholesterol from\n   4.71 ? 0.98 to 5.61 ? 1.6 mmol\/L and triglycerides from 2.04 ? 1.18 to 2.1 ?\n   0.72 mmol\/L) were not significant. They were stable during the whole\n   follow-up period. Ten patients were reconverted from SRL to CNI due to the\n   abrupt increase of proteinuria (from 298 ? 232 to 1639 ? 1641\/mg day in 7\n   patients), rapid growth of multiple ovarian cysts (2 patients) and operative\n   treatment of persisted hematoma (1 patient). Thirty days after reconversion\n   they were stable with an insignificant decrease in GFR (from 56.10 ? 28.09\n   to 47 ? 21 mL\/min) and significantly improved proteinuria (from 1639 ? 1641\n   to 529 ? 688 mg\/day). By the end of the follow-up these patients showed\n   nonsignificant increase in the serum creatinine (from 172 ? 88 to 202 ? 91\n   mmol\/L), decrease in GFR (from 56.10 ? 28.09 to 47 ? 21 mL\/day) and\n   increased proteinuria (from 528.9 ? 688 to 850 ? 1083 mg\/min). Conclusion.\n   In this small descriptive study, conversion from CNI to SRL was followed by\n   an increased incidence of infections and consecutive 25-50% dose reduction\n   in the second antiproliferative agent (AZA, MMF), with a possible influence\n   on the development of glomerulopathy in some patients, which was the major\n   reason for discontinuation of SRL therapy in the 7 (29%) patients. Nine\n   (37.5%) of the patients experienced the greatest benefit of CIN to SRL\n   conversion without serious post-conversion complications.<\/jats:p>","DOI":"10.2298\/vsp1309848i","type":"journal-article","created":{"date-parts":[[2013,9,17]],"date-time":"2013-09-17T06:32:53Z","timestamp":1379399573000},"page":"848-853","source":"Crossref","is-referenced-by-count":4,"title":["Conversion from calcineurin inhibitors to sirolimus of recipients with chronic kidney graft disease grade iii for a period 2003-2011"],"prefix":"10.2298","volume":"70","author":[{"given":"Ljiljana","family":"Ignjatovic","sequence":"first","affiliation":[{"name":"Military Medical Academy, Clinic of Nephrology, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajko","family":"Hrvacevic","sequence":"additional","affiliation":[{"name":"Military Medical Academy, Clinic of Nephrology, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dragan","family":"Jovanovic","sequence":"additional","affiliation":[{"name":"Military Medical Academy, Clinic of Nephrology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoran","family":"Kovacevic","sequence":"additional","affiliation":[{"name":"Military Medical Academy, Clinic of Nephrology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neven","family":"Vavic","sequence":"additional","affiliation":[{"name":"Military Medical Academy, Clinic of Nephrology, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Violeta","family":"Rabrenovic","sequence":"additional","affiliation":[{"name":"Military Medical Academy, Clinic of Nephrology, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleksandar","family":"Tomic","sequence":"additional","affiliation":[{"name":"University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Clinic of Vascular Surgery, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Predrag","family":"Aleksic","sequence":"additional","affiliation":[{"name":"University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Clinic of Urology, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biljana","family":"Draskovic-Pavlovic","sequence":"additional","affiliation":[{"name":"University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Institute for Medical Research, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleksandar","family":"Dujic","sequence":"additional","affiliation":[{"name":"Military Medical Academy, Institute for Medical Research, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeljko","family":"Karan","sequence":"additional","affiliation":[{"name":"Military Medical Academy, Center for Hospital Information System, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Djoko","family":"Maksic","sequence":"additional","affiliation":[{"name":"Military Medical Academy, Clinic of Nephrology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1078","container-title":["Vojnosanitetski pregled","Military Medical and Pharmaceutical Journal of Serbia"],"original-title":[],"language":"en","deposited":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T11:12:56Z","timestamp":1685358776000},"score":1,"resource":{"primary":{"URL":"https:\/\/doiserbia.nb.rs\/Article.aspx?ID=0042-84501309848I"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013]]},"references-count":0,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2013]]}},"URL":"https:\/\/doi.org\/10.2298\/vsp1309848i","relation":{},"ISSN":["0042-8450","2406-0720"],"issn-type":[{"value":"0042-8450","type":"print"},{"value":"2406-0720","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013]]}}}