PMID- 17717968
OWN - NLM
STAT- MEDLINE
DCOM- 20070919
LR  - 20181113
IS  - 1176-9114 (Print)
IS  - 1178-2013 (Electronic)
IS  - 1176-9114 (Linking)
VI  - 1
IP  - 3
DP  - 2006
TI  - Sirolimus therapy following early cyclosporine withdrawal in transplant patients: 
      mechanisms of action and clinical results.
PG  - 269-81
AB  - Cyclosporine (CsA), a member of the family of calcineurin inhibitors, is a 
      cornerstone of the immunosuppressive treatments used after organ transplantation. 
      However, it exhibits significant toxicity, including nephrotoxicity and increased 
      cardiovascular risk factors. CsA withdrawal has been used as a strategy to 
      improve renal allograft function and other CsA-related toxicities. In order to 
      maintain adequate immunosuppression levels, sirolimus may be used in association 
      with CsA withdrawal. Sirolimus is a member of the mammalian target of rapamycin 
      (mTOR) family. It presents a good immunosuppressive efficacy associated with 
      antiproliferative actions. Early withdrawal of CsA with sirolimus is associated 
      with a significant improvement of renal function. Despite numerically a higher 
      incidence of acute rejection episodes, this maneuver seems also to be associated 
      with a better allograft survival in the long-term, and improvement of renal 
      histology and blood pressure. However, CsA withdrawal is only feasible in a 
      selected population. Furthermore, the use of sirolimus is associated with other 
      side-effects including lipid abnormalities, abnormal liver tests, and 
      thrombocytopenia. Other studies are mandatory to define the population who can 
      benefit from this maneuver. Finally, complete CsA avoidance has been already 
      reported and is currently under clinical investigation.
FAU - Thervet, Eric
AU  - Thervet E
AD  - Service de Transplantation Renale, Hopital Necker, Paris, France. 
      eric.thervet@nck.aphp.fr
LA  - eng
PT  - Journal Article
PT  - Review
PL  - New Zealand
TA  - Int J Nanomedicine
JT  - International journal of nanomedicine
JID - 101263847
RN  - 0 (Immunosuppressive Agents)
RN  - 83HN0GTJ6D (Cyclosporine)
RN  - W36ZG6FT64 (Sirolimus)
SB  - IM
MH  - Clinical Trials as Topic
MH  - Cyclosporine/*administration & dosage/*adverse effects
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Graft Rejection/physiopathology/*prevention & control
MH  - Humans
MH  - Immunosuppressive Agents/adverse effects/therapeutic use
MH  - Kidney Diseases/*chemically induced/physiopathology/*prevention & control
MH  - Kidney Transplantation/*adverse effects
MH  - Sirolimus/*administration & dosage
PMC - PMC2426801
EDAT- 2007/08/28 09:00
MHDA- 2007/09/20 09:00
PMCR- 2007/01/01
CRDT- 2007/08/28 09:00
PHST- 2007/08/28 09:00 [pubmed]
PHST- 2007/09/20 09:00 [medline]
PHST- 2007/08/28 09:00 [entrez]
PHST- 2007/01/01 00:00 [pmc-release]
PST - ppublish
SO  - Int J Nanomedicine. 2006;1(3):269-81.