title: Calcineurin inhibitor-sparing regimens based on mycophenolic acid after kidney transplantation.
abstract: The use of calcineurin inhibitors (CNIs) has dramatically reduced the number of acute rejections and improved kidney allograft survival. However, CNIs can also cause kidney damage and several adverse events. This has prompted transplant physicians to use CNI-sparing regimens. CNI withdrawal, minimization, or avoidance protocols have been conducted using mycophenolic acid (MPA), and/or mammalian-target-of-rapamycin inhibitors, and/or belatacept. Herein, we review the outcomes of minimizing, withdrawing, or avoiding CNIs when giving mycophenolic acid to de novo and maintenance kidney transplant patients. Protocols on CNI withdrawal, when based on MPA without mammalian-target-of-rapamycin inhibitors (mTORi) or belatacept, in de novo and maintenance kidney transplant patients, are associated with an increased risk of acute rejection. Consequently, these strategies have been abandoned and are not recommended. Protocols on CNI minimization show a beneficial impact of kidney function and acceptable acute rejection rates mainly in patients who have been recipients of a graft for >3-5 years. However, no significant improvement to graft survival has been observed.
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.|Université Paul Sabatier, Toulouse, France.|INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.|Université Paul Sabatier, Toulouse, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Del Bello
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Belliere
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.|Université Paul Sabatier, Toulouse, France.|INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D065095:Calcineurin Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D028761:Withholding Treatment
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: calcineurin inhibitors; kidney transplantation; minimization; mycophenolic acid; withdrawal