Rationale and criteria of eligibility for calcineurin inhibitor interruption following kidney transplantation.
OBJECTIVE
To summarize predictive low-risk parameters of renal allograft recipients for purposes of improving the initiation of calcineurin inhibitor withdrawal protocols.


RESULTS
Clinical trials have demonstrated the potential global benefit of calcineurin inhibitor interruption protocols on graft survival despite being associated with an increased rate of acute rejection episodes, thus underlying a number of risk factors. Recent identification or confirmation of variables updating the list of parameters and molecular markers that can be used to predict graft outcome are described.


CONCLUSIONS
The effect of calcineurin inhibitor withdrawal on long-term graft and recipient survival patterns is assessed in relation to the large number of calcineurin inhibitor-related side-effects. However, current protocols are based on empirical observations and there is a clear requirement for reliable parameters to define patient eligibility for calcineurin inhibitor weaning procedures. Here, we review biological, clinical and genetic parameters that can be used as predictive markers of long-term graft outcome and could serve as criteria for patient selection in calcineurin inhibitor weaning protocols.
Danger
Richard
R
INSERM U643, Nantes, France.
Giral
Magali
M
Soulillou
Jean-Paul
JP
Brouard
Sophie
S
D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D065095:Calcineurin Inhibitors; D004334:Drug Administration Schedule; D020022:Genetic Predisposition to Disease; D006084:Graft Rejection / Q000235:genetics / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007674:Kidney Diseases / Q000139:chemically induced; D016030:Kidney Transplantation; D011110:Polymorphism, Genetic; D018570:Risk Assessment; D012307:Risk Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D015415:Biomarkers; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents