Replacing calcineurin inhibitors with proliferation signal inhibitors after kidney transplantation: indications, results, and disadvantages

Néphrologie & thérapeutique
V Audard

Abstract

In the kidney transplant patient, calcineurin inhibitor (CNI) treatment is a major risk factor for chronic allograft nephropathy (CAN). Immunosuppressive strategies based on non-nephrotoxic drugs such as proliferation signal inhibitors (PSIs) have been conceived to reduce or even interrupt CNIs. CNI conversion, with progressive cessation over 3 months with a PSI can significantly improve renal function, notably if the patient presents proteinuria less than 0.8 g/day and if conversion is undertaken early, when the glomerular filtration rate (GFR) is 40 ml/min or greater. In these conditions GRF improvement is associated with a histological CADI score and chronic lesion markers. Nevertheless, replacing CNIs with a PSI can occasionally induce proteinuria that is potentially related to direct toxicity of the PSI on the podocytes, which must be monitored to prevent recurrence of nephrotoxicity lesions.

References

Jan 1, 1997·Kidney International·D SerónJ Alsina
Apr 12, 2002·The Journal of Biological Chemistry·Annabelle GrolleauLaura Beretta
May 14, 2003·Transplantation Proceedings·E Morelon, H Kreis
Dec 4, 2004·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Herwig-Ulf Meier-KriescheBruce Kaplan
Jun 10, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Atul V MulayGreg A Knoll
Jun 30, 2005·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Viorica BumbeaLionel Rostaing
Apr 25, 2007·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Fritz DiekmannJosep M Campistol
Aug 21, 2007·Clinical Journal of the American Society of Nephrology : CJASN·Emmanuel LetavernierChristophe Legendre
Apr 25, 2008·Journal of the American Society of Nephrology : JASN·Alexandre HertigYi-Chun Xu-Dubois

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Citations

Sep 26, 2013·Therapeutic Drug Monitoring·David J TaberPrabhakar Baliga

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