PMID- 25959589
OWN - NLM
STAT- MEDLINE
DCOM- 20160411
LR  - 20211203
IS  - 1432-2277 (Electronic)
IS  - 0934-0874 (Linking)
VI  - 28
IP  - 8
DP  - 2015 Aug
TI  - Immunosuppressive minimization with mTOR inhibitors and belatacept.
PG  - 921-7
LID - 10.1111/tri.12603 [doi]
AB  - Immunosuppressive therapy after kidney transplantation consists of a calcineurin 
      inhibitor (CNI)-based therapy in combination with mycophenolic acid and steroids 
      in most cases. In spite of low acute rejection rates and excellent graft 
      survival, it is associated with major long-term complications, such as 
      cardiovascular events, malignancy, and nephrotoxicity, and does not favor 
      tolerogenic processes. Mammalian target of rapamycin (mTOR) inhibitors in 
      combination with low-dose CNI offer good rejection rates and acceptable allograft 
      function; however, de novo mTOR inhitibor-based treatment in combination with 
      mycophenolate is not widely used due to higher acute rejection rates. Early 
      conversion from a CNI to an mTOR inhibitor is a feasible option in selected 
      patients with a slightly higher acute rejection rate, but equal or better GFR. 
      Costimulation blockade has been proven to facilitate antirejection prophylaxis 
      without CNI-associated side effects. So far, belatacept has been approved in 
      combination with mycophenolate and steroids with better graft function, however, 
      a slightly higher acute rejection rate. Recently, the combination of an mTOR 
      inhibitor and belatacept with lymphocyte-depleting antibody induction and without 
      maintenance steroids has been explored in two pilot studies with very low acute 
      rejection rates, very good graft function, and an acceptable side effect profile.
CI  - (c) 2015 Steunstichting ESOT.
FAU - Diekmann, Fritz
AU  - Diekmann F
AD  - Department of Nephrology and Kidney Transplantation, Hospital Clinic, Barcelona, 
      Spain.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20150608
PL  - Switzerland
TA  - Transpl Int
JT  - Transplant international : official journal of the European Society for Organ 
      Transplantation
JID - 8908516
RN  - 0 (Calcineurin Inhibitors)
RN  - 0 (Immunosuppressive Agents)
RN  - 7D0YB67S97 (Abatacept)
RN  - 9HW64Q8G6G (Everolimus)
RN  - EC 2.7.1.1 (MTOR protein, human)
RN  - EC 2.7.11.1 (TOR Serine-Threonine Kinases)
RN  - W36ZG6FT64 (Sirolimus)
SB  - IM
MH  - Abatacept/*therapeutic use
MH  - Calcineurin Inhibitors/therapeutic use
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Everolimus/*therapeutic use
MH  - Graft Rejection/immunology/*prevention & control
MH  - Humans
MH  - Immunosuppression Therapy/adverse effects/*methods
MH  - Immunosuppressive Agents/*therapeutic use
MH  - *Kidney Transplantation
MH  - Sirolimus/*therapeutic use
MH  - TOR Serine-Threonine Kinases/antagonists & inhibitors
OTO - NOTNLM
OT  - clinical immunosuppression
OT  - costimulation blockade
OT  - mTOR inhibition
EDAT- 2015/05/12 06:00
MHDA- 2016/04/12 06:00
CRDT- 2015/05/12 06:00
PHST- 2014/11/02 00:00 [received]
PHST- 2014/12/17 00:00 [revised]
PHST- 2015/05/02 00:00 [accepted]
PHST- 2015/05/12 06:00 [entrez]
PHST- 2015/05/12 06:00 [pubmed]
PHST- 2016/04/12 06:00 [medline]
AID - 10.1111/tri.12603 [doi]
PST - ppublish
SO  - Transpl Int. 2015 Aug;28(8):921-7. doi: 10.1111/tri.12603. Epub 2015 Jun 8.