Minimization of calcineurin inhibitors to improve long-term outcomes in kidney transplantation.
Long-term outcomes after kidney transplantation remain suboptimal, despite the great achievements observed in recent years with the use of modern immunosuppressive drugs. Currently, the calcineurin inhibitors (CNI) cyclosporine and tacrolimus remain the cornerstones of immunosuppressive regimens in many centers worldwide, regardless of their well described side-effects, including nephrotoxicity. In this article, we review recent CNI-minimization strategies in kidney transplantation, while emphasizing on the importance of long-term follow-up and patient monitoring. Finally, accumulating data indicate that low-dose CNI-based regimens would provide an interesting balance between efficacy and toxicity.
Golshayan
Dela
D
Centre Hospitalier Universitaire Vaudois , Lausanne University, 1011 Lausanne, Switzerland. Dela.Golshayan@chuv.ch
Pascual
Manuel
M
D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage; D000963:Antimetabolites / Q000008:administration & dosage; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000008:administration & dosage; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000401:mortality; D016559:Tacrolimus / Q000008:administration & dosage; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000963:Antimetabolites; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D016572:Cyclosporine; D016559:Tacrolimus