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.