title: [Minimization of immunosuppression].
abstract: Minimization protocols: The goal of minimization protocols is to reduce the load of immunosuppressant agents after transplantation. Besides the basic medical objective of reduced deleterious effects of long-term immunosuppression, minimization also has an economic impact. Discontinuation of corticosteroid therapy: Results obtained with different minimization protocols have shown that any interruption of corticosteroid therapy, even if associated with the new immunosuppressants, should be conducted carefully in selected patients, tapering off late after transplantation. Mycophenolate-mofetil (MMF): MMF withdraw may be risked and the beneficial effect of discontinuation remains to be demonstrated. Calcineurin inhibitors: Most immunosuppression protocols use cyclosporine. The benefit obtained by totally discontinuing cyclosporine in stabilized patients does not outbalance the risks induced by withdrawal. However, in this population, MMF can be useful for tapering down cyclosporine. In patients with altered renal function, introduction of MMF or sirolimus can allow a reduction in dosage or complete withdrawal of cyclosporine.
authors.affiliation: Hôpital Saint-Louis, Paris.
authors.forename: E
authors.initials: E
authors.lastname: Thervet
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D016572:Cyclosporine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007668:Kidney / Q000187:drug effects; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D016377:Organ Transplantation; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus