IMMUNOSUPPRESSIVE PROTOCOLS Sirolimus as Primary Immunosuppression Agent in Kidney Transplant Recipients: Akdeniz University Experience G.U. Karatas, U. Yakupoglu, Y.K. Yakupoglu, H. Kocak, A. Yavuz, A. Dinckan, M. Tuncer, A. Demirbas, G. Yakupoglu, F.F. Ersoy, and A. Gurkan ABSTRACT Objectives. Recently usage of sirolimus as the primary immunosuppressant is widening among kidney transplant recipients. We reviewed the clinical follow-up of patients transplanted at our center using sirolimus protocols. Methods. Sirolimus including primary immunosuppressive treatment protocols were begun in February 2002. Among the 21 patients (15 men, six women) who received sirolimus, six patients were prescribed sirolimus + prednisolone; seven, sirolimus + mycophenolate mofetil + prednisolone; and eight, sirolimus + cyclosporine + pred- nisolone. The mean age of the patients was 32.9  7.3 years and the mean posttransplan- tation follow-up, 13.2  4.5 months. Results. Three patients experienced acute rejection episodes, which were treated success- fully with steroids. None of the patients had either hematologic or wound healing problems. Lymphoceles developed in eight patients. Serum creatinine level was 1.4  0.5 mg/dL at 12 months. There was a serious increase in serum cholesterol and triglyceride levels starting from the first month posttransplant (total cholesterol levels pretransplant and at 1 month, respectively: 159.3  29.5 and 255.7  52.3 mg/dL, P = .0001; triglycerides pretransplant and at 1 month, respectively: 146.9  89.5 and 215.1  102.5 mg/dL, P = .001). Despite routine antihyperlipemic treatment those high levels were maintained for 12 months. Conclusions. We achieved 100% graft and patient survival rates for 1 year among patients who were using sirolimus. But the most important role in defining the morbidity and mortality in this group of patients is cardiovascular events; for this reason the abnormalities in the lipid profile must be taken seriously. S IROLIMUS (rapamycin; Rapamune), a macrocyclic lactone produced by the Streptomyces hyroscopicus, was first isolated from the soil of the Vai Atari region of Rapa Nui. 1,2 It possesses immunosuppressive and antiprolifera- tive properties by blocking the responses of various cell types to growth factors through inhibition of the mTOR signal cascade. 3 Both in vitro and preclinical studies have confirmed the immunosuppressive properties of siroli- mus. It complexes with FK binding protein, resulting in suppression of cytokine-driven T-cell proliferation by inhibiting progression from the G1 to the S phase of the cell cycle. 4,5 From the Akdeniz University Organ Transplantation Center, Antalya, Turkey. Address reprint requests to Alihan Gurkan, MD, Akdeniz University Organ Transplantation Center, 07070 Antalya, Turkey. E-mail: alihangurkan2004@yahoo.com 0041-1345/05/$–see front matter © 2005 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2005.08.021 360 Park Avenue South, New York, NY 10010-1710 3006 Transplantation Proceedings, 37, 3006 –3008 (2005)