title: Mammalian Target of Rapamycin Inhibitor Monotherapy: Efficacy in Renal Transplantation.
abstract: BACKGROUND
  Calcineurin inhibitors (CNI) have failed to improve long-term outcomes in renal transplantation. Anti-proliferative and anti-angiogenic effects of mammalian target of rapamycin inhibitors (m-TOR) without nephrotoxicity could improve long-term survival in selected transplant recipients.
  
  
  METHODS
  We examined the evolution of 98 low-immunological risk renal transplant recipients on m-TOR monotherapy: 7 patients had induction without CNI and 91 were switched to m-TOR at 12 (p25-p75: 4-36) months after transplant.
  
  
  RESULTS
  Median follow-up time was 46 (p25-p75: 28.5-72.0) months. Fifteen recipients dropped out of the study (15.3%): 8 patients (8.2%) had to change their immunosuppressive treatment because of complications and 7 (7.1%) lost their grafts as a result of chronic rejection (4 cases) or death with a functioning graft (3 cases). At the end of follow-up, 83 of 98 (84.6%) recipients remained on monotherapy. The rates of recipient and graft survivals were 100% and 98.8% at 2 years and 96.9% and 93.5% at 4 years; the percentages of patients on monotherapy after 2 and 4 years were 95.2% and 85.2%, respectively. Renal function improved significantly and proteinuria decreased but not significantly. Those patients switched to m-TOR significantly received more erythropoietin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and hypotensive agents than before starting m-TOR, whereas there were no significant changes related to the use of statins, body weight, or percentage of diabetic patients. No case of non-compliance was reported.
  
  
  CONCLUSIONS
  This study supports the safety and efficacy of monotherapy with m-TOR in selected renal transplant recipients.
authors.affiliation: Department of Nephrology, Hospital General Universitario de Alicante, Alicante, Spain. Electronic address: franco_ant@gva.es.
authors.forename: A
authors.initials: A
authors.lastname: Franco
authors.affiliation: Department of Pharmacy, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Más-Serrano
authors.affiliation: Department of Nephrology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Perez Contreras
authors.affiliation: Department of Nephrology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Jiménez
authors.affiliation: Department of Nephrology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Rodriguez
authors.affiliation: Department of Nephrology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Olivares
mesh_terms: D000328:Adult; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D004921:Erythropoietin / Q000627:therapeutic use; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria; D020123:Sirolimus / Q000627:therapeutic use*; D015996:Survival Rate; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D004921:Erythropoietin; D000068338:Everolimus; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus