Calcineurin inhibitor-free immunosuppression after heart transplantation: can chronic side effects be avoided?
| Autor: | Jan Groetzner, Thorsten Wahlers |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Heart transplantation
Oncology Transplantation medicine.medical_specialty business.industry medicine.medical_treatment Renal function Immunosuppression Mycophenolate law.invention Calcineurin Randomized controlled trial law Internal medicine Sirolimus Immunology and Allergy Medicine business Adverse effect medicine.drug |
| Zdroj: | Current Opinion in Organ Transplantation. 10:360-363 |
| ISSN: | 1087-2418 |
| DOI: | 10.1097/01.mot.0000186947.23438.3e |
| Popis: | Purpose of review This paper discusses the recent findings on the subject of whether calcineurin inhibitor-free immunosuppressive regimens might be feasible and safe. Randomized trials and longer-term follow-up will help to establish whether such regimens could be used to avoid or reverse the chronic side effects associated with calcineurin inhibitors. Recent findings The introduction of mycophenolate mofetil and sirolimus resulted in several approaches to begin long-term immunosuppression independently of calcineurin inhibitors. In patients with calcineurin inhibitor toxicity, calcineurin inhibitor withdrawal resulted in a reversal of calcineurin inhibitor-induced renal failure in most reports. Conversion to mycophenolate mofetil and steroids was associated with improved renal function, but the incidence of rejections and graft vessel disease increased. In contrast, mycophenolate mofetil combined with sirolimus as conversion therapy improved renal function and was efficacious and safe. Therefore, interest is growing in de-novo calcineurin inhibitor-free regimens to completely avoid calcineurin inhibitor toxicity. Unfortunately, most reports of calcineurin inhibitor-free immunosuppression were retrospective analyses, and only two prospective, but noncomparative, studies exist. Summary First experiences with calcineurin inhibitor-free immunosuppression after heart transplantation are made as a conversion approach and as de-novo therapy. The superiority in safety and efficacy of calcineurin inhibitor-free immunosuppression has to be proven in randomized trials. Longer follow-up will answer the question regarding the prevention of adverse events like renal failure or graft vessel disease and prolongation of patients' survival. |
| Databáze: | OpenAIRE |
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