Abstract

HERNANDEZ, D. et al. Clinical evidence on the use of anti-mtor drugs in renal transplantation. Nefrología (Madr.) [online]. 2011, vol.31, n.1, pp.27-34. ISSN 1989-2284.

The calcineurin inhibitor drugs (CNI) are the mainstays of modern immunosuppression in renal transplantation, but they contribute significantly to the chronic graft loss and the high morbidity and mortality in this population for their deleterious effects on renal graft, cardiovascular profile and malignancies. The anti-mTOR drugs, sirolimus (SRL) and verolimus (EVE), are potent immunosuppressants with antiproliferative and anti-migration properties. This confers them a potential protective role in graft dysfunction, the optimization of renal function and the appearance of malignancies. Indeed, clinical trials and observational studies have demonstrated that conversion from CNI to anti-mTOR-based maintanace therapy has beneficial effects on transplant outcomes in terms of renal function, without significant increase in acute rejection rates. In this review, we analyze the evidence of the use of anti-mTOR in the following clinical situations following renal transplantation: 1) Prevention of immune dysfunction and renal function preservation in de novo kidney transplantation and after early or late CNI withdrawal; 2) Chronic graft dysfunction, 3) Cardiovascular complications, 4) Diabetes de novo posttransplantation; and 5) De novo malignancies.

Keywords : Renal transplantation; Anti-mTOR drugs; Proliferation signal inhibitors; Sirolimus; Everolimus.

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