{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T07:02:51Z","timestamp":1779692571842,"version":"3.53.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nephrol."],"abstract":"\n Objective<\/jats:title>\n Calcineurin inhibitors, such as tacrolimus, are associated with long-term nephrotoxicity and renal allograft dysfunction despite evidence of improved kidney transplantation outcomes. Consequently, minimizing calcineurin inhibitor exposure has attracted considerable interest. This study aimed to investigate the long-term outcomes of late conversion of tacrolimus to sirolimus in a steroid-free immunosuppressive regimen in kidney transplant recipients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted an 8-year retrospective analysis of outcomes in 207 kidney transplant recipients enrolled in a previous randomized clinical trial, in which patients receiving maintenance therapy with tacrolimus and mycophenolate were randomized 2:1 at 6\u201312 months post-transplantation to conversion from tacrolimus to sirolimus or continuation of tacrolimus.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Over the 8-year post-transplant follow-up, the sirolimus cohort exhibited a superior and more preserved GFR compared to the tacrolimus cohort, with a total GFR change of \u22121.18 mL\/min\/1.73 m\u00b2 (95% CI, \u22124.86 to 3.06) with sirolimus versus \u22129.57 mL\/min\/1.73 m\u00b2 (95% CI, \u221216.92 to \u22127.26) with tacrolimus, with a between-group difference of \u22128.39 mL\/min\/1.73 m\u00b2. The two groups did not significantly differ in terms of graft loss, patient survival, or\n de novo<\/jats:italic>\n donor-specific antibody development. The sirolimus group showed a numerically but insignificantly elevated biopsy-proven acute rejection rate. Adverse effect profiles revealed that the sirolimus group was associated with significantly lower BK viremia and cancer rates, whereas other adverse events did not significantly differ between the groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Delayed conversion from tacrolimus to sirolimus (\u22656 months post-transplantation) was associated with long-term preserved estimated glomerular filtration rate without a significantly increased risk of renal allograft rejection or graft loss.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneph.2026.1813146","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:05:19Z","timestamp":1779689119000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term outcomes of tacrolimus conversion to sirolimus in kidney transplant recipients: an eight-year follow-up"],"prefix":"10.3389","volume":"6","author":[{"given":"Ibrahim","family":"Tawhari","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Nephrology, King Khalid University College of Medicine","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sook","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatmah","family":"Yamani","sequence":"additional","affiliation":[{"name":"Department of Nephrology, King Faisal Specialist Hospital & Research Centre - Jeddah","place":["Jeddah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Javeed","family":"Ansari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Tawhari","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]},{"name":"Department of Medicine, Division of Nephrology, King Abdulaziz Medical City in Riyadh, Ministry of National Guard \u2013 Health Affairs","place":["Riyadh, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Leventhal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Gallon","sequence":"additional","affiliation":[{"name":"University of Illinois Chicago","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa021744","article-title":"Chronic renal failure after transplantation of a nonrenal organ","volume":"349","author":"Ojo","year":"2003","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2007091001","article-title":"Long-term efficacy and safety of a 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