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Calcineurin inhibitor sparing in renal transplantation

Ekberg, Henrik LU (2008) In Transplantation 86(6). p.761-767
Abstract
Although calcineurin inhibitors (CNIs) are effective at preventing a cute rejection, their long-term use is associated with nephrotoxicity that may compromise long-term renal allograft Survival. Consequently, there is considerable interest in identifying immunosuppressive regimens that permit reduced exposure to CNIs while maintaining adequate immunosuppression. Introducing such strategies early after transplantation may mean that the development of CNI-associated nephrotoxicity could be minimized or prevented. Several CNI-sparing regimens have shown at least comparable efficacy with standard-dos CNI regimens. In particular, a regimen of mycophenolate mofetil (MMF), corticosteroids, interleukin-2 receptor antagonist induction, and low-dose... (More)
Although calcineurin inhibitors (CNIs) are effective at preventing a cute rejection, their long-term use is associated with nephrotoxicity that may compromise long-term renal allograft Survival. Consequently, there is considerable interest in identifying immunosuppressive regimens that permit reduced exposure to CNIs while maintaining adequate immunosuppression. Introducing such strategies early after transplantation may mean that the development of CNI-associated nephrotoxicity could be minimized or prevented. Several CNI-sparing regimens have shown at least comparable efficacy with standard-dos CNI regimens. In particular, a regimen of mycophenolate mofetil (MMF), corticosteroids, interleukin-2 receptor antagonist induction, and low-dose tacrolimus from the time of transplantation provided superior renal function and a lower acute rejection rate than the same regimen but with low-dose cyclosporine or low-close sirolimus, or standard-dose cyclosporine, MMF, and corticosteroids. The use of low-dose cyclosporine does not seem to eliminate nephrotoxicity in de novo renal transplant recipients. The early withdrawal of CNIs from MMF-based regimens generally improves renal function but has been associated with an increased risk of acute rejection, in particular when the levels of mycophenolic acid were not adjusted to maintain the same total level Of immunosuppression. Research aiming to achieve the "best" balance of efficacy and toxicity of available immunosuppressive regimens continues. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
renal, mycophenolate mofetil, nephrotoxicity, calcineurin inhibitors, transplantation
in
Transplantation
volume
86
issue
6
pages
761 - 767
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000259594600002
  • scopus:56049102618
ISSN
1534-6080
DOI
10.1097/TP.0b013e3181856f39
language
English
LU publication?
yes
id
6825a4a1-7002-4d75-afd5-e977377d5fd7 (old id 1286174)
date added to LUP
2009-02-04 09:33:09
date last changed
2017-08-27 04:48:17
@article{6825a4a1-7002-4d75-afd5-e977377d5fd7,
  abstract     = {Although calcineurin inhibitors (CNIs) are effective at preventing a cute rejection, their long-term use is associated with nephrotoxicity that may compromise long-term renal allograft Survival. Consequently, there is considerable interest in identifying immunosuppressive regimens that permit reduced exposure to CNIs while maintaining adequate immunosuppression. Introducing such strategies early after transplantation may mean that the development of CNI-associated nephrotoxicity could be minimized or prevented. Several CNI-sparing regimens have shown at least comparable efficacy with standard-dos CNI regimens. In particular, a regimen of mycophenolate mofetil (MMF), corticosteroids, interleukin-2 receptor antagonist induction, and low-dose tacrolimus from the time of transplantation provided superior renal function and a lower acute rejection rate than the same regimen but with low-dose cyclosporine or low-close sirolimus, or standard-dose cyclosporine, MMF, and corticosteroids. The use of low-dose cyclosporine does not seem to eliminate nephrotoxicity in de novo renal transplant recipients. The early withdrawal of CNIs from MMF-based regimens generally improves renal function but has been associated with an increased risk of acute rejection, in particular when the levels of mycophenolic acid were not adjusted to maintain the same total level Of immunosuppression. Research aiming to achieve the "best" balance of efficacy and toxicity of available immunosuppressive regimens continues.},
  author       = {Ekberg, Henrik},
  issn         = {1534-6080},
  keyword      = {renal,mycophenolate mofetil,nephrotoxicity,calcineurin inhibitors,transplantation},
  language     = {eng},
  number       = {6},
  pages        = {761--767},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Transplantation},
  title        = {Calcineurin inhibitor sparing in renal transplantation},
  url          = {http://dx.doi.org/10.1097/TP.0b013e3181856f39},
  volume       = {86},
  year         = {2008},
}