title: Chronic allograft nephropathy--a clinical syndrome: early detection and the potential role of proliferation signal inhibitors.
abstract: 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.
authors.affiliation: Servei de Nefrologia i Transplantament Renal, Renal Transplant Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Campistol
authors.forename: Ioannis N
authors.initials: IN
authors.lastname: Boletis
authors.forename: Jacques
authors.initials: J
authors.lastname: Dantal
authors.forename: Johan W
authors.initials: JW
authors.lastname: de Fijter
authors.forename: Alexandre
authors.initials: A
authors.lastname: Hertig
authors.forename: Hans H
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Ole
authors.initials: O
authors.lastname: Oyen
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.forename: Erich
authors.initials: E
authors.lastname: Pohanka
authors.forename: Juan C
authors.initials: JC
authors.lastname: Ruiz
authors.forename: Maria P
authors.initials: MP
authors.lastname: Scolari
authors.forename: Sergio
authors.initials: S
authors.lastname: Stefoni
authors.forename: Daniel
authors.initials: D
authors.lastname: Serón
authors.forename: Vito
authors.initials: V
authors.lastname: Sparacino
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Arns
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
mesh_terms: 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
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D019703:Calcineurin; D020123:Sirolimus