NDT Advance Access originally published online on December 16, 2005
Nephrology Dialysis Transplantation 2006 21(3):562-568; doi:10.1093/ndt/gfi336
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Editorial Comment
Conversion from calcineurin inhibitors to sirolimus in chronic allograft nephropathy: benefits and risks
1 Department of Nephrology and Renal Transplantation, Hospital Clínic and IDIBAPS, University of Barcelona, Spain and 2 Department of Nephrology, Charité Campus Mitte, Humboldt University, Berlin, Germany
Correspondence and offprint requests to: Dr. Fritz Diekmann, Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel, 170, E-08036, Barcelona, Spain. Email: diekmann11@yahoo.es; fritz.diekmann@web.de
Keywords: chronic allograft nephropathy; conversion; cyclosporine A; proteinuria; sirolimus; tacrolimus
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Introduction |
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Chronic allograft nephropathy (CAN) is the most prevalent cause of late kidney transplant failure characterized by progressive loss of graft function in combination with proteinuria and hypertension [1]. Both immunological and non-immunological factors play a role in the development of CAN, and calcineurin inhibitor (CNI) therapy has been identified to be an important non-immunological cause [2–5]. In this context, Nankivell et al. [5] demonstrated in a protocol biopsy study that at least grade I CAN could be diagnosed in all biopsy specimens 3 years after transplantation, and that histological signs of chronic CNI nephrotoxicity are omnipresent after 10 years.
Sirolimus (SRL) is a new, potent, non-nephrotoxic immunosuppressive agent that possesses antiproliferative properties and exerts anti-tumour activity by various mechanisms [6–8]. In a large multicentre study, elimination of cyclosporine A (CsA) after 3 months from a protocol containing SRL and CsA was
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Conversion from CNI to SRL for deteriorating graft function – the clinical experience |
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Conversion from CNI to SRL for CAN – who will benefit? |
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How to convert from CNI to SRL? – how to avoid the pitfalls? |
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Conclusion |
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