Calcineurin inhibitor-free immunosuppression in kidney transplantation

Giselle Guerra, Titte R. Srinivas, Herwig Ulf Meier-Kriesche

Research output: Contribution to journalArticle

41 Citations (Scopus)

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 languageEnglish
Pages (from-to)813-827
Number of pages15
JournalTransplant International
Volume20
Issue number10
DOIs
StatePublished - Oct 1 2007
Externally publishedYes

Fingerprint

Kidney Transplantation
Immunosuppression
Immunosuppressive Agents
Transplants
Mycophenolic Acid
Kidney
Controlled Clinical Trials
Tacrolimus
Graft Survival
Sirolimus
Standard of Care
Cyclosporine
Calcineurin Inhibitors
Safety

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 journalArticle

Guerra, Giselle ; Srinivas, Titte R. ; Meier-Kriesche, Herwig Ulf. / Calcineurin inhibitor-free immunosuppression in kidney transplantation. In: Transplant International. 2007 ; Vol. 20, No. 10. pp. 813-827.
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