Chronic allograft nephropathy--a clinical syndrome: early detection and the potential role of proliferation signal inhibitors.
Chronic allograft nephropathy (CAN) leads to the majority of late graft loss following renal transplantation. Detection of CAN is often too late to permit early intervention and successful management. Most current strategies for managing CAN rely on minimizing or eliminating calcineurin inhibitors (CNIs) once CAN has become established. The proliferation signal inhibitors everolimus and sirolimus have potent immunosuppressive and antiproliferative actions, with the potential to alter the natural history of CAN by reducing CNI exposure whilst avoiding acute rejection. Whilst data will be forthcoming from a number of clinical trials investigating this potential, we discuss early detection of CAN and the rationale for a role for this class of agent.
Campistol
Josep M
JM
Servei de Nefrologia i Transplantament Renal, Renal Transplant Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
Boletis
Ioannis N
IN
Dantal
Jacques
J
de Fijter
Johan W
JW
Hertig
Alexandre
A
Neumayer
Hans H
HH
Oyen
Ole
O
Pascual
Julio
J
Pohanka
Erich
E
Ruiz
Juan C
JC
Scolari
Maria P
MP
Stefoni
Sergio
S
Serón
Daniel
D
Sparacino
Vito
V
Arns
Wolfgang
W
Chapman
Jeremy R
JR
D019703:Calcineurin / Q000378:metabolism; D065095:Calcineurin Inhibitors; D049109:Cell Proliferation; D002908:Chronic Disease; D051799:Delayed Graft Function / Q000175:diagnosis* / Q000378:metabolism / Q000517:prevention & control; D042241:Early Diagnosis; D000068338:Everolimus; D005919:Glomerular Filtration Rate; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D011379:Prognosis; D015398:Signal Transduction / Q000187:drug effects*; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D013577:Syndrome; D014184:Transplantation, Homologous
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D019703:Calcineurin; D020123:Sirolimus