Conversion to Proliferation Signal Inhibitors–Based Immunosuppressive Regimen in Kidney Transplantation: To Whom and When?

Randomized Controlled Trial of Sirolimus Conversion in Cardiac Transplant Recipients With Renal Insufficiency

“…An antiproliferative agent acting through inhibition of T lymphocyte activation via mammalian target of rapamycin (mTOR) inhibition (11), sirolimus does not exhibit nephrotoxic effects on renal function similar to those of CNIs (12). Regimens utilizing sirolimus in the absence of CNIs in renal and cardiac transplant recipients improved renal function (8,9,(12)(13)(14)(15). Several studies wherein cardiac transplant recipients with mild to moderate renal failure were converted from CNI to sirolimus reported an associated improvement in renal function (8,13,14).…”

Everolimus immunosuppression in kidney transplantation: What is the optimal strategy?

“…As seen in studies of pre-emptive conversion to everolimus, a shorter time post-transplant was associated with greater renal benefit [52] and patients with very poor baseline renal function tended to progress to end-stage renal disease [48].…”

“…The literature includes a number of single-center reports from small series of maintenance kidney transplant patients who were switched from CNI therapy to everolimus in response to declining renal function [45,46], malignant neoplasms or nonmelanoma skin cancer [47][48][49][50] or, more frequently, a mixture of indications but primarily renal deterioration or malignancy [51][52][53][54]. Studies of cohorts switched due to renal causes or for mixed reasons have consistently shown a significant improvement in renal function over follow-up periods ranging from six months to two years [45,46,[51][52][53][54].…”

“…Studies of cohorts switched due to renal causes or for mixed reasons have consistently shown a significant improvement in renal function over follow-up periods ranging from six months to two years [45,46,[51][52][53][54].…”

Efficacy of everolimus in ABO-incompatible kidney transplantation: a retrospective study

“…Their use has decreased the acute rejection rate and has improved short-term patient survival and graft survival. 4 However, in the long term, CNIs are associated with chronic graft dysfunction owing to CNI nephrotoxicity, submit your manuscript | www.dovepress.com…”