Abstract
The introduction of calcineurin inhibitors (CNI) revolutionized kidney transplantation (KTx). Exceptionally low acute rejection rates and excellent graft survival could be achieved with CNI-based (cyclosporine and tacrolimus) immunosuppressive protocols. However, despite short-term success, long-term graft attrition continues to be a significant problem, thus leaving clinicians looking for possible interventions. CNI nephrotoxicity is but one of numerous factors that may be contributing to long-term damage in transplant kidneys. Therefore, newer immunosuppressive agents such as mycophenolate mofetil and sirolimus (Rapa) have raised the possibility of withdrawing or avoiding CNIs altogether. Protocols exploring these options have gained greater attention over the last few years. Herein, we review studies addressing either CNI withdrawal or CNI avoidance strategies as well as discuss the risks versus benefits of these protocols. Given the accumulated experience to date, in our opinion, the use of CNIs as a part of immunosuppressive regimens remains the proven standard of care for renal transplant patients. The long-term safety and efficacy of CNI withdrawal and avoidance strategies need to be further validated in controlled clinical trials.
| Original language | English |
|---|---|
| Pages (from-to) | 813-827 |
| Number of pages | 15 |
| Journal | Transplant International |
| Volume | 20 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2007 |
| Externally published | Yes |
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Keywords
- Calcineurin inhibitors
- Immunosuppression
- m-TOR inhibitors
- Mycophenolate mofetil
ASJC Scopus subject areas
- Transplantation
Cite this
Calcineurin inhibitor-free immunosuppression in kidney transplantation. / Guerra, Giselle; Srinivas, Titte R.; Meier-Kriesche, Herwig Ulf.
In: Transplant International, Vol. 20, No. 10, 01.10.2007, p. 813-827.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Calcineurin inhibitor-free immunosuppression in kidney transplantation
AU - Guerra, Giselle
AU - Srinivas, Titte R.
AU - Meier-Kriesche, Herwig Ulf
PY - 2007/10/1
Y1 - 2007/10/1
N2 - The introduction of calcineurin inhibitors (CNI) revolutionized kidney transplantation (KTx). Exceptionally low acute rejection rates and excellent graft survival could be achieved with CNI-based (cyclosporine and tacrolimus) immunosuppressive protocols. However, despite short-term success, long-term graft attrition continues to be a significant problem, thus leaving clinicians looking for possible interventions. CNI nephrotoxicity is but one of numerous factors that may be contributing to long-term damage in transplant kidneys. Therefore, newer immunosuppressive agents such as mycophenolate mofetil and sirolimus (Rapa) have raised the possibility of withdrawing or avoiding CNIs altogether. Protocols exploring these options have gained greater attention over the last few years. Herein, we review studies addressing either CNI withdrawal or CNI avoidance strategies as well as discuss the risks versus benefits of these protocols. Given the accumulated experience to date, in our opinion, the use of CNIs as a part of immunosuppressive regimens remains the proven standard of care for renal transplant patients. The long-term safety and efficacy of CNI withdrawal and avoidance strategies need to be further validated in controlled clinical trials.
AB - The introduction of calcineurin inhibitors (CNI) revolutionized kidney transplantation (KTx). Exceptionally low acute rejection rates and excellent graft survival could be achieved with CNI-based (cyclosporine and tacrolimus) immunosuppressive protocols. However, despite short-term success, long-term graft attrition continues to be a significant problem, thus leaving clinicians looking for possible interventions. CNI nephrotoxicity is but one of numerous factors that may be contributing to long-term damage in transplant kidneys. Therefore, newer immunosuppressive agents such as mycophenolate mofetil and sirolimus (Rapa) have raised the possibility of withdrawing or avoiding CNIs altogether. Protocols exploring these options have gained greater attention over the last few years. Herein, we review studies addressing either CNI withdrawal or CNI avoidance strategies as well as discuss the risks versus benefits of these protocols. Given the accumulated experience to date, in our opinion, the use of CNIs as a part of immunosuppressive regimens remains the proven standard of care for renal transplant patients. The long-term safety and efficacy of CNI withdrawal and avoidance strategies need to be further validated in controlled clinical trials.
KW - Calcineurin inhibitors
KW - Immunosuppression
KW - m-TOR inhibitors
KW - Mycophenolate mofetil
UR - http://www.scopus.com/inward/record.url?scp=34548593235&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34548593235&partnerID=8YFLogxK
U2 - 10.1111/j.1432-2277.2007.00528.x
DO - 10.1111/j.1432-2277.2007.00528.x
M3 - Article
C2 - 17645419
AN - SCOPUS:34548593235
VL - 20
SP - 813
EP - 827
JO - Transplant International
JF - Transplant International
SN - 0934-0874
IS - 10
ER -