Nephrol Dial Transplant (2000) 15: 1307-1309
© 2000 European Renal Association-European Dialysis and Transplant Association
Personal Opinion
Calcineurin-inhibitors in renal transplantation. Too precious to be abandoned
Division of Nephrology and Dialysis, IRCCS Ospedale Maggiore di Milano, Milan, Italy
Introduction
Drugs which inhibit the calcineurin enzymatic complex may be responsible for renal toxicity, which is occasionally progressive and irreversible. Thus, in spite of improving results obtained with the use of calcineurin inhibitors in the field of renal transplantation, many physicians are concerned about the long-term use of these agents and try to replace them sooner or later with non-nephrotoxic immunosuppressive agents such as azathioprine, mycophenolate mofetil, and/or rapamycin. Before this policy is generally adopted, however, one should consider the results that can be achieved today with the correct use of calcineurin inhibitors.
The main aims of modern immunosuppression are: (i) to minimize risk and outcome of acute rejection; (ii) to reduce the risk of comorbidity caused by immunosuppressive agents, particularly corticosteroids; and (iii) to reduce late graft failure caused by chronic rejection. All these goals may be achieved through administration of the calcineurin inhibitors, cyclosporin (CsA) or tacrolimus (FK) respectively,
Acute rejection
Steroid-free immunosuppression
Late graft failures
Notes
References
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