Renal protection strategies after heart transplantation
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Renal protection strategies after heart transplantation. / Reichart, Daniel; Reichenspurner, Hermann; Barten, Markus Johannes.
in: CLIN TRANSPLANT, Jahrgang 32, Nr. 1, 01.2018.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Renal protection strategies after heart transplantation
AU - Reichart, Daniel
AU - Reichenspurner, Hermann
AU - Barten, Markus Johannes
N1 - © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2018/1
Y1 - 2018/1
N2 - Renal dysfunction caused by calcineurin inhibitor (CNI) nephrotoxicity occurs often and contributes significantly to late mortality after heart transplantation (HTx). Over the last decades, this has prompted many clinical studies in an effort to develop kidney-protecting immunosuppressive strategies including delayed CNI start, minimization, withdrawal, or even de novo CNI avoidance. In the past, these strategies often failed due to the lack of efficacy. Since 2009, novel CNI-reducing strategies have been under investigation. These strategies minimize renal damage using induction agents such as antithymocyte globulin and alternative immunosuppressive agents such as the mechanistic target of rapamycin inhibitors (sirolimus or everolimus) or mycophenolate. This review outlines the recent results of using these renal protection strategies including their drawbacks. We also discuss alternative approaches to optimize individual immunosuppressive therapies after HTx.
AB - Renal dysfunction caused by calcineurin inhibitor (CNI) nephrotoxicity occurs often and contributes significantly to late mortality after heart transplantation (HTx). Over the last decades, this has prompted many clinical studies in an effort to develop kidney-protecting immunosuppressive strategies including delayed CNI start, minimization, withdrawal, or even de novo CNI avoidance. In the past, these strategies often failed due to the lack of efficacy. Since 2009, novel CNI-reducing strategies have been under investigation. These strategies minimize renal damage using induction agents such as antithymocyte globulin and alternative immunosuppressive agents such as the mechanistic target of rapamycin inhibitors (sirolimus or everolimus) or mycophenolate. This review outlines the recent results of using these renal protection strategies including their drawbacks. We also discuss alternative approaches to optimize individual immunosuppressive therapies after HTx.
KW - Heart Diseases/surgery
KW - Heart Transplantation/adverse effects
KW - Humans
KW - Immunosuppressive Agents/therapeutic use
KW - Kidney Diseases/etiology
KW - Prognosis
U2 - 10.1111/ctr.13157
DO - 10.1111/ctr.13157
M3 - SCORING: Review article
C2 - 29151264
VL - 32
JO - CLIN TRANSPLANT
JF - CLIN TRANSPLANT
SN - 0902-0063
IS - 1
ER -