Home > Journals > Minerva Urologica e Nefrologica > Past Issues > Minerva Urologica e Nefrologica 2006 March;58(1) > Minerva Urologica e Nefrologica 2006 March;58(1):23-8

CURRENT ISSUE
 

ARTICLE TOOLS

Reprints

MINERVA UROLOGICA E NEFROLOGICA

A Journal on Nephrology and Urology


Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536


eTOC

 

REVIEWS  


Minerva Urologica e Nefrologica 2006 March;58(1):23-8

language: English

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

Kingston R. W. C., Goldsmith D. J. A.

Department of Renal Medicine and Transplantation Guy’s Hospital, London,UK


PDF  


In renal transplantation the calcineurin inhibitors (CNIs) have played a crucial role in the reduction in acute rejection rates. Unfortunately this has not been matched by an improvement in long-term graft survival rate. The development of chronic allograft nephropathy (CAN) is the second most common cause of graft loss, after death from cardiovascular causes. CAN has a multifactorial aetiology that includes immunological and nonimmunological factors relating to both donor and recipient. The use of CNIs has been strongly implicated as a risk factor for the development of CAN. With the ongoing development of new immunosuppressant agents the possibility of avoiding the CNIs now exists. Many studies have been designed to investigate strategies to minimise or avoid CNI exposure and to prolong graft survival. To achieve CNI withdrawal whilst avoiding rejection, additional immunosuppressants need to be substituted into the drug regimen. Long-term side effects of the immunosuppressant used need to be taken into account when drug changes are being considered. In light of current evidence, CNI reduction with optimal use of mycophenolate mofetil appears to be the most effective strategy in managing the patient with CAN.

top of page

Publication History

Cite this article as

Corresponding author e-mail