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(sirolimus) is a new generation of powerful immunosuppressant. It not only has little nephrotoxicity, but also has anti-proliferation and anti-tumor effects. It can reduce liver and kidney toxicity and other adverse reactions in kidney transplant recipients, and significantly improve transplanted kidney function. The application of this drug also provides kidney transplant recipients with the opportunity to withdraw calcineurin inhibitor drugs.

At present, patients can either go to major domestic hospitals to purchase the required rapamycin (sirolimus), or contact some domestic professional overseas medical service institutions to obtain the same drug sold overseas through online purchase.

Sirolimus causes hyperlipidemia in a significant dose- and concentration-dependent manner, with cholesterol and triacylglycerol levels decreasing within one or two months as the dose of sirolimus is reduced or discontinued. Foreign reports indicate that 5-15 μg/L is the appropriate concentration range for sirolimus. Domestic scholars believe that it is more appropriate to maintain the concentration at 4-8 μg/L and 6-10 μg/L. Most adverse reactions occur at the higher dose recommended abroad, that is, the concentration of 10-15 μg/L. As long as the dose is adjusted in time, the occurrence of adverse reactions can be reduced.

Some researchers believe that: 1-3 months after kidney transplantation, it is 4-6 μg/L, 4-6 months is 3-6 μg/L, and >6 months is 3-5 μg/L. Within this concentration range, rapamycin combined with mycophenolate mofetil and prednisone can achieve better immunosuppressive effects and fewer adverse reactions.

After renal transplantation, the blood creatinine creeps up and the sirolimus regimen has a significant effect. Before switching to rapamycin (i.e., sirolimus) treatment, a biopsy of the transplanted kidney is performed to confirm the diagnosis of calcineurin inhibitor nephrotoxicity or chronic allograft nephropathy. Combined with the blood creatinine level, a comprehensive judgment is made as to whether to switch to treatment. "Patients on the verge of switching" should not miss the switch opportunity and pay attention to monitoring blood lipid levels; switch should be carried out before serious damage to the function of the transplanted kidney. Patients will benefit more from early switch.

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