Treatment With Sirolimus Is Associated With Less Weight Gain After Kidney Transplantation

BACKGROUND: Immunosuppression after kidney transplantation has been associated with weight gain. The aim was to evaluate if sirolimus (SRL) had a different effect on weight gain than calcineurin inhibitor (CNI). METHODS: Data on body weight in different patient populations were analyzed at several time points: (a) SRL (CNI-free) versus cyclosporine A (CsA) treatment de novo, (b) CsA+SRL versus CsA (SRL-free) treatment de novo, (c) SRL+tacrolimus elimination at 3 months versus SRL+mycophenolate mofetil versus tacrolimus+mycophenolate mofetil de novo, and (d) conversion from CNI to SRL versus CNI in maintenance patients. RESULTS: Patients were analyzed from de novo transplantation trials (n=1863) and from the conversion study (n=742). At baseline, weight in the SRL-containing and SRL-free treatment arms was not different, but weight gain was significantly less pronounced in SRL in de novo treatment (group 1: 2.8±4.6 vs. 6.2±6.6 kg every 2 years, P=0.020; group 2: 6.1±9.5 vs. 9.6±9.1 kg every 2 years, P<0.001; and group 3: 3.7±7.0 vs. 3.5±6.2 vs. 5.9±9.0 kg every 1 year, P=0.042). In the conversion study, patients lost weight in the SRL arm and gained weight in the CNI arm (-1.0±6.0 vs. +1.0±5.1 kg every 2 years; P<0.001). CONCLUSION: SRL treatment is associated with less weight gain de novo as well as in late conversion.