Sirolimus: not so sparing in the Spare-the-Nephron trial

Shamseddin, M. Khaled; Gupta, Ankur

doi:10.1038/ki.2011.88

Cited by 3 publications

(3 citation statements)

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“…2.6.4 Late conversion to SRL Many prospective trials and retrospective studies assessed the benefit of late conversion to prevent deteriorating renal function [154,[156][157][158][159]. The largest prospective trial is the CON-VERT-study, which randomized 830 patients 6 --120 months after transplantation to either continue CNI or CNI withdrawal to SRL.…”

Section: Conversion To Srlmentioning

confidence: 99%

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An evaluation of sirolimus in renal transplantation

Halleck¹,

Duerr²,

Waiser³

et al. 2012

Expert Opinion on Drug Metabolism & Toxicology

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Sirolimus enriches the possibilities of immunosuppressive therapies after renal transplantation. Beneficial effects toward kidney function by allowing CNI sparing, lower incidence of malignancies and less viral infections have been suggested. Sirolimus should be used cautiously in de novo patients for reasons of wound healing. An early conversion to a sirolimus-based CNI-free regimen has shown promising results, whereas late conversion is more challenging. Finally, sirolimus-associated side effects are causing tolerability concerns and frequent discontinuations. Future research should aim to better define the therapeutic window and those patients most likely to benefit.

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Section: Conversion To Srlmentioning

confidence: 99%

“…Limitations are potentially more rejections and multiple side effects resulting in high re-conversion rates ( Table 3). Additional long-term data, the rigorous comparison to low TAC/MPA regimens [156] and the analysis of DSA [152] are needed from ongoing trials to fully evaluate the risks and benefits of early conversion.…”

Section: Conversion To Srlmentioning

confidence: 99%

An evaluation of sirolimus in renal transplantation

Halleck¹,

Duerr²,

Waiser³

et al. 2012

Expert Opinion on Drug Metabolism & Toxicology

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“…8 Flechner 9 reported that at 1-2 years of their study, the GFR was superior for the SRL group, with a loss of tolerability for about 20%. Moreover, Shamseddin and Gupta,10 in a letter to the editor, questioned the sparing effect of SRL in the Spare-the-Nephron trial. 11 CsA is cyclic, non-ribosomal peptide of fungal origin containing eleven amino acids including a single D-amino acid.…”

Section: Introductionmentioning

confidence: 99%

Next-generation calcineurin inhibitors in development for the prevention of organ rejection

Gheith¹,

Al-Otaibi²,

Mansour³

2014

TRRM

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Calcineurin inhibitors (CNIs) remain the cornerstone of immunosuppression after renal transplantation despite their adverse effects. Some CNIs have well known negative impacts on the cardiovascular system, including hypertension, hyperlipidemia, new onset diabetes after transplantation (NODAT), neurotoxicity, hypertrichosis, and nephrotoxicity. Many clinical trials dealing with CNI avoidance or elimination were associated with higher risk of rejection of the transplanted organ. New generation CNIs are concerned with modifying CNI molecules so that they become more potent and are suitable for patients with suboptimal adherence with less adverse effects. In this review, we address these issues.

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The Author Replies:

Weir

2011

Kidney International

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Sirolimus: not so sparing in the Spare-the-Nephron trial

Cited by 3 publications

References 1 publication

An evaluation of sirolimus in renal transplantation

An evaluation of sirolimus in renal transplantation

Next-generation calcineurin inhibitors in development for the prevention of organ rejection

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