[Replacing calcineurin inhibitors with proliferation signal inhibitors after kidney transplantation: indications, results, and disadvantages].
In the kidney transplant patient, calcineurin inhibitor (CNI) treatment is a major risk factor for chronic allograft nephropathy (CAN). Immunosuppressive strategies based on non-nephrotoxic drugs such as proliferation signal inhibitors (PSIs) have been conceived to reduce or even interrupt CNIs. CNI conversion, with progressive cessation over 3 months with a PSI can significantly improve renal function, notably if the patient presents proteinuria less than 0.8 g/day and if conversion is undertaken early, when the glomerular filtration rate (GFR) is 40 ml/min or greater. In these conditions GRF improvement is associated with a histological CADI score and chronic lesion markers. Nevertheless, replacing CNIs with a PSI can occasionally induce proteinuria that is potentially related to direct toxicity of the PSI on the podocytes, which must be monitored to prevent recurrence of nephrotoxicity lesions.
Service de Néphrologie et Transplantation Rénale, Institut Francilien de Recherche en Néphrologie et Transplantation, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, France. vincent.audard@hmn.aphp.fr
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D000368:Aged; D065095:Calcineurin Inhibitors; D000068338:Everolimus; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus