Antioxidative Status in the Early Post-Transplant Period: Cyclosporine A-based vs Sirolimus-based Regimens

Background and Aims: It is renowned that the principal causes of oxidative stress will disappear after transplantation. However, it does not seem to improve totally, which may be due to an immunologic response to the graft or possibly immunosuppressive agents. This study was conducted to investigate the possible relation between oxidative stress and different immunosuppressive regimens (cyclosporine versus sirolimus based) in renal transplant patients.

Methods: Twenty-five renal transplanted patients with uneventful operation and stable function were randomly assigned to one regimen of immunosuppressive protocols cyclosporine (CsA) (Group A) or sirolimus (Group B) plus mycophenolate mofetil (MMF) and Steroids. Erythrocyte Glutathione (GSH), Superoxide dismutase activity, plasma malondialdehyde (MDA) and α-tocopherol were measured and compared.

Results: There were no significant changes of SOD activity in CsA group in different days. However, there was a significant reduction of SOD activity in sirolimus group 14 days after transplantation. Erythrocyte GSH did not show any significant changes between the groups. Plasma MDA and vitamin E level were not significantly different between the groups before and 48 hour after transplantation.‍‍ Considerably higher MDA (1.82 ± 0.43 vs. 1.03 ± 0.12, µmol/l, p<0.05) and vitamin E levels (0.18 ± 0.008 vs. 0.12 ± 0.006 µmol/l, p<0.05) were seen 2 weeks after transplantation in sirolimus group compared to CsA group.

Discussion: The results of the present study showed that although sirolimus-treated recipients had decreased activity of SOD in 14^th day of transplantation but no alteration of GSH during this period in comparison with cyclosporine-treated recipients was found. Increased level of plasma vitamin E on 14^th day was possibly a secondary response to the change of MDA level.

Conclusions: It seems that sirolimus may not offer better protection against increased reactive oxygen species (ROS) production in early period of renal transplantation.