Sirolimus-Based Immunosuppressive Regimens in Renal Transplantation: A Systemic Review

被引:13
|
作者
Zhao, D. Q. [1 ]
Li, S. W. [1 ]
Sun, Q. Q. [1 ]
机构
[1] Sun Yat Sen Univ, Kidney Transplantat Dept, Affiliated Hosp 3, Guangzhou 510275, Guangdong, Peoples R China
关键词
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.
引用
收藏
页码:3 / 9
页数:7
相关论文
共 50 条
  • [41] Sirolimus-based immunosuppression following liver transplantation for hepatocellular carcinoma.
    Zimmerman, Michael A.
    Trotter, James F.
    Wachs, Michael
    Bak, Tom
    Campsen, Jeffrey
    Kam, Igal
    AMERICAN JOURNAL OF TRANSPLANTATION, 2008, 8 : 470 - 470
  • [42] Determining Renal Resistive and Pulsatility Indexes Long-Term After Kidney Transplantation in Kidney Transplant Recipients on Cyclosporine A-, Tacrolimus-, or Sirolimus-Based Regimens
    Boran, M.
    Tola, M.
    Boran, M.
    Boran, E.
    Gonenc, F.
    TRANSPLANTATION PROCEEDINGS, 2014, 46 (05) : 1324 - 1327
  • [43] Kidney transplantation: Advantages of long-term sirolimus-based therapy
    Wilhelm, E
    PERFUSION, 2003, 16 (08): : 307 - 309
  • [44] Sirolimus-based immunosuppression after liver transplantation: A single centre experience
    Harper, Simon J. F.
    Gelson, William
    Goncalves, Ines
    Sasidharan, Manoj
    Drage, Martin
    Alexander, Graeme
    Gibbs, Paul
    TRANSPLANT INTERNATIONAL, 2007, 20 : 31 - 31
  • [45] A randomized controlled trial of late conversion from CNI-based to sirolimus-based immunosuppression following renal transplantation
    Watson, CJE
    Firth, J
    Williams, PF
    Bradley, JR
    Pritchard, N
    Chaudhry, A
    Smith, JC
    Palmer, CR
    Bradley, JA
    AMERICAN JOURNAL OF TRANSPLANTATION, 2005, 5 (10) : 2496 - 2503
  • [46] Calcineurin inhibitor withdrawal from sirolimus-based therapy in kidney transplantation: A systematic review of randomized trials
    Oberbauer, R
    AMERICAN JOURNAL OF TRANSPLANTATION, 2005, 5 (12) : 3023 - 3023
  • [47] Single-center experience with tacrolimus-based immunosuppressive regimens in renal transplantation
    Abou-Jaoude, MM
    Almawi, WY
    MOLECULAR IMMUNOLOGY, 2003, 39 (17-18) : 1067 - 1072
  • [48] CLINICAL EFFICACY OF SIROLIMUS-BASED QUADRUPLE THERAPY IN THE TREATMENT OF ACUTE REJECTION AT THE EARLY STAGE AFTER RENAL TRANSPLANTATION
    Wang, Weigang
    Wang, Yuantao
    Zhou, Honglan
    Li, Ping
    Wang, Gang
    Fu, Yaowen
    HUMAN IMMUNOLOGY, 2011, 72 : S95 - S95
  • [49] De novo sirolimus-based regimen in Thai renal transplant recipients
    Townamchai, N.
    Avihingsanon, Y.
    Praditpornsilpa, K.
    Tungsanga, K.
    Eiam-Ong, S.
    TRANSPLANTATION PROCEEDINGS, 2008, 40 (07) : 2206 - 2208
  • [50] Comparison of sirolimus with low-dose tacrolimus versus sirolimus-based calcineurin inhibitor-free regimen in live donor renal transplantation
    Hamdy, AF
    El-Agroudy, AE
    Bakr, MA
    Mostafa, A
    El-baz, M
    El-Shahawy, EM
    Ghoneim, MA
    AMERICAN JOURNAL OF TRANSPLANTATION, 2005, 5 (10) : 2531 - 2538