Induction therapy and mTOR Inhibition: minimizing calcineurin inhibitor exposure in de novo renal transplant patients
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Induction therapy and mTOR Inhibition: minimizing calcineurin inhibitor exposure in de novo renal transplant patients. / Nashan, Björn.
in: CLIN TRANSPLANT, Jahrgang 27 Suppl 25, 2013, S. 16-29.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Induction therapy and mTOR Inhibition: minimizing calcineurin inhibitor exposure in de novo renal transplant patients
AU - Nashan, Björn
N1 - © 2013 John Wiley & Sons A/S.
PY - 2013
Y1 - 2013
N2 - Use of induction therapy with mTOR inhibitor maintenance immunosuppression to facilitate reduced calcineurin inhibitor (CNI) exposure in de novo kidney transplant patients has been explored in a series of randomized trials. These studies have typically employed interleukin-2 receptor antagonist (IL-2RA) induction, in low or standard immunological risk recipients. Although no study has directly compared mTOR inhibition plus reduced CNI exposure with or without induction, inclusion of IL-2RA induction appears to permit a substantial reduction in CNI exposure without the need for high mTOR inhibitor dosing. IL-2RA induction with an mTOR inhibitor and steroids has consistently shown similar efficacy to standard-exposure CNI with mycophenolic acid and steroids and may improve renal function among patients who remain on the mTOR inhibitor-based regimen. With modern mTOR inhibitor dosing, wound healing complications are of less concern and may be no more frequent than in mycophenolic acid-based regimens. The incidence of cytomegalovirus infection appears lower in patients receiving de novo mTOR inhibition. The available evidence demonstrates that IL-2RA induction with an mTOR inhibitor can successfully reduce CNI exposure by at least half without a penalty in terms of rejection in low- or moderate-risk de novo transplant recipients and may offer renal and antiviral benefits.
AB - Use of induction therapy with mTOR inhibitor maintenance immunosuppression to facilitate reduced calcineurin inhibitor (CNI) exposure in de novo kidney transplant patients has been explored in a series of randomized trials. These studies have typically employed interleukin-2 receptor antagonist (IL-2RA) induction, in low or standard immunological risk recipients. Although no study has directly compared mTOR inhibition plus reduced CNI exposure with or without induction, inclusion of IL-2RA induction appears to permit a substantial reduction in CNI exposure without the need for high mTOR inhibitor dosing. IL-2RA induction with an mTOR inhibitor and steroids has consistently shown similar efficacy to standard-exposure CNI with mycophenolic acid and steroids and may improve renal function among patients who remain on the mTOR inhibitor-based regimen. With modern mTOR inhibitor dosing, wound healing complications are of less concern and may be no more frequent than in mycophenolic acid-based regimens. The incidence of cytomegalovirus infection appears lower in patients receiving de novo mTOR inhibition. The available evidence demonstrates that IL-2RA induction with an mTOR inhibitor can successfully reduce CNI exposure by at least half without a penalty in terms of rejection in low- or moderate-risk de novo transplant recipients and may offer renal and antiviral benefits.
KW - Calcineurin
KW - Graft Rejection
KW - Humans
KW - Immunosuppressive Agents
KW - Interleukin-2 Receptor alpha Subunit
KW - Kidney Diseases
KW - Kidney Transplantation
KW - Postoperative Complications
KW - Randomized Controlled Trials as Topic
KW - Remission Induction
KW - TOR Serine-Threonine Kinases
U2 - 10.1111/ctr.12156
DO - 10.1111/ctr.12156
M3 - SCORING: Journal article
C2 - 23909498
VL - 27 Suppl 25
SP - 16
EP - 29
JO - CLIN TRANSPLANT
JF - CLIN TRANSPLANT
SN - 0902-0063
ER -
