EARLY CYCLOSPORINE WITHDRAWAL;
LONG-TERM TRIAL;
CALCINEURIN INHIBITOR-MINIMIZATION;
EARLY STEROID WITHDRAWAL;
DE-NOVO SIROLIMUS;
MYCOPHENOLATE-MOFETIL;
KIDNEY-TRANSPLANTATION;
RANDOMIZED-TRIAL;
OPEN-LABEL;
TACROLIMUS/MYCOPHENOLATE MOFETIL;
D O I:
10.1016/j.transproceed.2016.01.002
中图分类号:
R392 [医学免疫学];
Q939.91 [免疫学];
学科分类号:
100102 ;
摘要:
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.
机构:
Univ Fed Sao Paulo, Hosp Rim, Div Nefrol, Sao Paulo, BrazilUniv Fed Sao Paulo, Hosp Rim, Div Nefrol, Sao Paulo, Brazil
Tedesco-Silva, Helio
del Carmen Rial, Maria
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h-index: 0
机构:
Nephrol SA, Inst Nefrol, Buenos Aires, DF, ArgentinaUniv Fed Sao Paulo, Hosp Rim, Div Nefrol, Sao Paulo, Brazil
del Carmen Rial, Maria
Cruz Santiago, Jose
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h-index: 0
机构:
IMSS Mexico, Hosp Especialidades CMN La Raza, Mexico City, DF, MexicoUniv Fed Sao Paulo, Hosp Rim, Div Nefrol, Sao Paulo, Brazil
Cruz Santiago, Jose
Mazzali, Marilda
论文数: 0引用数: 0
h-index: 0
机构:
Univ Estadual Campinas, Sao Paulo, BrazilUniv Fed Sao Paulo, Hosp Rim, Div Nefrol, Sao Paulo, Brazil
Mazzali, Marilda
Pacheco-Silva, Alvaro
论文数: 0引用数: 0
h-index: 0
机构:
Univ Fed Sao Paulo, Hosp Rim, Div Nefrol, Sao Paulo, Brazil
Hosp Israelita Albert Einstein, Sao Paulo, BrazilUniv Fed Sao Paulo, Hosp Rim, Div Nefrol, Sao Paulo, Brazil
Pacheco-Silva, Alvaro
Torres, Rodolfo
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h-index: 0
机构:
Fdn Univ Ciencias Salud, Clin Univ Colombia, Bogota, ColombiaUniv Fed Sao Paulo, Hosp Rim, Div Nefrol, Sao Paulo, Brazil