title: Sirolimus-Based Immunosuppressive Regimens in Renal Transplantation: A Systemic Review.
abstract: Sirolimus (SRL)-based immunosuppressive regimens have been used for preventing rejection after kidney transplantation. This review analyzes their merits and demerits compared with other conventional regimes from the aspects of acute rejection rate, graft function, as well as patient/graft survival rates. In general, SRL is mostly recommended to be used as conversion therapy from calcineurin inhibitor (CNI) after kidney transplantation in most studies. Minimization or withdrawal of cyclosporine A (CsA) could also be considered when it was combined with SRL. SRL can replace mycophenolate mofetil (MMF), and the CNI dose should be reduced appropriately in this setting. Quadruple maintenance regimens containing SRL need future study to clarify their superiority. De novo use of low-dose CNI combined with SRL has no apparent merits and thus is not recommended. De novo use of standard-dose CNI combined with SRL followed by maintenance, de novo use of CNI-free regimens, as well as SRL use in delayed graft function (DGF) patients who spare antibody induction and postpone CNI administration should also be avoided. SRL supports steroids withdrawal after kidney transplantation, and SRL combined with tacrolimus is recommended in this setting. Loading dose is recommended when initiating SRL treatment and its trough blood level should be routinely monitored.
authors.affiliation: Kidney Transplantation Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: D Q
authors.initials: DQ
authors.lastname: Zhao
authors.affiliation: Kidney Transplantation Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: S W
authors.initials: SW
authors.lastname: Li
authors.affiliation: Kidney Transplantation Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Electronic address: sunqiquan@hotmail.com.
authors.forename: Q Q
authors.initials: QQ
authors.lastname: Sun
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011184:Postoperative Period; D020123:Sirolimus / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D016572:Cyclosporine; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus; D013256:Steroids; D016559:Tacrolimus