Sirolimus-based therapy for kidney transplantation from expanded criteria donors.
The new class of immunosuppressants--inhibitors of the mammalian target of rapamycin--has no nephrotoxicity and the capacity to inhibit vascular smooth cell proliferation. These characteristics may afford considerable clinical advantages in the transplantation of kidneys from expanded criteria donors (ECD). Six clinical experiences of the use of sirolimus (SRL) in ECD kidneys recipients have been reported in the literature. Although the results varied somewhat, probably due to differences in the types of deceased donor and in the immunosuppressive regimens used, it seems that a calcineurin inhibitor free, SRL-based protocol can assure a good immunosuppressive effect with less nephrotoxicity and a low incidence of cytomegalovirus infection. For recipients of ECD kidneys at low immunological risk, we would recommend a regimen based on antithymocyte globulin induction and SRL, mycophenolate mofetil, and steroids for maintenance. For strongly responding recipients, we recommend SRL combined with a reduced, 76% to 87% dose of calcineurin inhibitor.
Rigotti
Paolo
P
Department of General Surgery and Organ Transplantation, University of Padua, Italy. paolo.rigotti@unipd.it
Kahan
Barry D
BD
D000368:Aged; D002102:Cadaver; D002986:Clinical Trials as Topic; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D008487:Medical History Taking; D018579:Patient Selection; D011183:Postoperative Complications / Q000517:prevention & control / Q000821:virology; D020123:Sirolimus / Q000627:therapeutic use*; D014019:Tissue Donors / Q000706:statistics & numerical data* / Q000600:supply & distribution
D007166:Immunosuppressive Agents; D020123:Sirolimus