[Immunosuppressive strategies and chronic graft dysfunction in kidney transplantation].
Chronic graft dysfunction is a major cause of return to dialysis. In the majority of cases, it is correlated with histological signs of cellular and/or humoral rejection, the nephrotoxicity of anticalcineurins, or nonspecific lesions of interstitial fibrosis and tubular atrophy. Although the incidence of acute rejection has considerably decreased, renal toxicity of the calcineurin inhibitors remains problematic. In cases of established nephrotoxicity, the use of non-nephrotoxic immunosuppressors such as mycophenolic acid or the proliferation signal inhibitors makes it possible to reduce or even stop the anticalcineurins. In prevention of anticalcineurin nephrotoxicity, many attempts to minimize or wean patients from them have shown that improvement in renal function is only obtained at the cost of an increase in the incidence of acute rejection. This makes it necessary to select patients who may benefit from anticalcineurin-sparing treatment, based on clinical, histological, and biological markers. Finally, long-term follow-up is also fundamental in order to validate the positive impact on renal function of this strategy in terms of graft survival.
Hazzan
M
M
Pôle de Néphrologie, CHRU de Lille, boulevard du Pr Leclercq, 59037 Lille cedex, France. mhazzan@gmail.com
Glowacki
F
F
Lionet
A
A
Provot
F
F
Noël
C
C
D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005355:Fibrosis; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000145:classification / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology; D007683:Kidney Tubular Necrosis, Acute / Q000139:chemically induced / Q000628:therapy; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D018579:Patient Selection; D055031:Primary Graft Dysfunction / Q000139:chemically induced* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012306:Risk
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid