Optimizing the clinical utility of sirolimus-based immunosuppression for kidney transplantation.

Autor: Tedesco-Silva H; Divisão de Nefrologia, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil., Del Carmen Rial M; Instituto de Nefrologia, Nephrology SA, Institucion afiliada a Universidad de Buenos Aires, Buenos Aires, Argentina., Cruz Santiago J; Hospital de Especialidades CMN La Raza IMSS Mexico, Mexico City, Mexico., Mazzali M; University of Campinas, São Paulo, Brazil., Pacheco-Silva A; Divisão de Nefrologia, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil.; Hospital Israelita Albert Einstein, São Paulo, Brazil., Torres R; Clínica Universitaria Colombia, Fundacion Universitária de Ciencias de la Salud, Bogotá, Colombia.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2019 Feb; Vol. 33 (2), pp. e13464. Date of Electronic Publication: 2019 Jan 02.
DOI: 10.1111/ctr.13464
Abstrakt: While calcineurin inhibitors (CNIs) are effective for preventing acute rejection in kidney transplant recipients, long-term use may cause chronic kidney injury and is associated with increased risks of cardiovascular events, cancer, and infection-associated death. Immunosuppression strategies are needed to balance risks of acute and subclinical rejection with long-term benefits of improved kidney function. Sirolimus, an inhibitor of mammalian target of rapamycin, is used for immunosuppression in kidney transplantation. Its clinical utility has evolved, over more than 15 years, including de novo sirolimus with and without concomitant CNIs and conversion from CNI-based regimens to sirolimus. Sirolimus-containing regimens are associated with preservation of good renal function, with promising characteristics for improving long-term graft and patient survival, including antiviral and anticancer effects. Based on clinical evidence, use of low-dose sirolimus in a de novo approach with tacrolimus/steroids in the immediate posttransplantation period is appropriate. A feasible alternative is a long term, CNI-free combination with mycophenolate mofetil (following CNI-to-sirolimus conversion at 3-6 months). These strategies are appropriate for a broad range of patients with various levels of immunologic risk, including those receiving expanded criteria donor kidneys or at increased risk of delayed graft function, particular challenges in Latin America and other global regions.
(© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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