Long-term results in renal transplant patients with allograft dysfunction after switching from calcineurin inhibitors to sirolimus

Bumbea, V.; Kamar, Nassim; Ribes, David; Esposito, Laure; Modesto, Anne; Guitard, Joëlle; Nasou, Ghassan; Durand, Dominique; Rostaing, Lionel

doi:10.1093/ndt/gfh957

Cited by 160 publications

(123 citation statements)

References 19 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…27,28 Conversion of CNI to Sirolimus is also useful for patients with CNI induced nephrotoxicity, [29][30][31] but it causes proteinuria and may worsen renal function in patients with pre-existing renal disease. 32,33 Sirolimus impairs wound healing as it impairs action of TGFb, 34 hence it is usually avoided in the early post operative period. In addition, it may cause interstitial pneumonitis, peripheral edema and dermatological side effects (acne, mouth ulcers).…”

Section: Mtor Inhibitorsmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

show abstract

Section: Mtor Inhibitorsmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

show abstract

“…• Fever (23% to 34%), chest pain, headache, insomnia, fatigue, Arthralgia, alterations in taste, and asthenia are common side effects and can be managed by reducing the drug dose [1,3,15].…”

Section: Reported Side Effects Of M-tori Includesmentioning

confidence: 99%

“…Reasons behind that were attributed to the adverse effects of immunosuppressant's, with allograft loss mainly due to chronic allograft nephropathy (CAN) [1,3].…”

Section: Introductionmentioning

confidence: 99%

“…CAN describe the inevitable steady decrease in renal capacity with time; characteristically renal biopsy shows tubular atrophy, interstitial fibrosis, glomerulosclerosis and vascular occlusive changes [1,3].…”

Section: Introductionmentioning

confidence: 99%

“…lower nephrotoxicity, less hypertension and perhaps a protective probability against neoplastic activities) than CNI therapy [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

m-TOR Inhibitors in the Current Practice

Alalawi¹,

Sharma²,

Halawa³

2017

J Clin Exp Nephrol

View full text Add to dashboard Cite

Abstractfor long time, calcineurin-inhibitors (CNIs) was the best broadly used immunosuppressant in organ transplantation; since it had proven its efficacy in the reduction of acute rejection episodes and early graft loss, though their use in the long-term, are associated with chronic allograft nephropathy (CAN), besides it increases the cardiovascular risks such as diabetes, hypertension, and dyslipidemias. Moreover, CNIs in combination with other immunosuppressant's increases the risk of fatal infections and malignancy. Ultimately the introduction of the mammalian focus of rapamycin (mTOR) inhibitors, such as sirolimus and everolimus in 1990s, had changed the face of transplantation and conveyed a great hope to transplant physicians as an innovative class of effective immunosuppressants with a unique mechanism and less nephrotoxic effects (1-6).In this review article we will try briefly to elicit the clinical indications, advantage and disadvantage of m-TOR inhibitors over other immunosuppressant's medications and their clinical indications inside and outside the transplant field.

show abstract