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Chronic renal allograft dysfunction: the evidence for a change in immunosuppression

R W C Kingston1, D J A Goldsmith

  • 1Department of Renal Medicine and Transplantation, Guy's Hospital, London,UK.

Minerva Urologica E Nefrologica = the Italian Journal of Urology and Nephrology
|June 9, 2006
PubMed

Insights

Calcineurin inhibitors (CNIs) reduce acute rejection in renal transplants but increase chronic allograft nephropathy (CAN). Reducing CNI use, particularly with mycophenolate mofetil, may improve long-term graft survival.

Area of Science:

  • Nephrology
  • Immunosuppression
  • Transplantation

Background:

  • Calcineurin inhibitors (CNIs) are vital for reducing acute rejection in renal transplantation.
  • However, CNIs have not improved long-term graft survival and are implicated in chronic allograft nephropathy (CAN).
  • CAN is a major cause of graft loss, stemming from diverse immunological and non-immunological factors.

Purpose of the Study:

  • To investigate strategies for minimizing or avoiding CNI exposure to enhance long-term renal allograft survival.
  • To explore alternative immunosuppressive regimens to prevent rejection during CNI withdrawal.

Main Methods:

  • Review of existing studies on CNI withdrawal and alternative immunosuppression.
  • Analysis of factors contributing to CAN.
  • Evaluation of long-term side effects of immunosuppressants.

Main Results:

  • CNI use is a significant risk factor for developing CAN.
  • Newer immunosuppressants offer potential for CNI avoidance.
  • Careful substitution of other immunosuppressants is necessary to prevent rejection.

Conclusions:

  • CNI reduction, combined with optimal mycophenolate mofetil use, is the most effective current strategy for managing patients with CAN.
  • This approach aims to improve long-term graft survival by mitigating CNI-related toxicity.

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