Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Jornal Brasileiro de Nefrologia |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002017000100070 |
Resumo: | Abstract Registry studies and systematic reviews have shown higher risk for mortality and graft loss in patients in use of mTOR inhibitors (mTORi) compared to calcineurin-based (CNI) immunosuppressive regimens. The majority of these studies pooled data from early trials using different strategies such as "de novo" combination of the high dose mTOR inhibitors with standard dose of CNI or high dose mTORi combined with mycophenolate. The large heterogeneity of these initial exploratory studies, many of them no longer in use, turns difficult any comparison with a well-defined standard of care regimen. The new strategies using concentration controlled reduced exposure of mTORi and CNI or early conversion from CNI to mTORi use have shown comparable patient and graft survival. Nevertheless, considering the central role of mTOR in health and disease states, more research is necessary to mitigate the adverse events and to explore further the potential beneficial effects of mTOR inhibitors. |
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Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitorsmortalitykidney transplantationserine-threonine kinasessirolimusAbstract Registry studies and systematic reviews have shown higher risk for mortality and graft loss in patients in use of mTOR inhibitors (mTORi) compared to calcineurin-based (CNI) immunosuppressive regimens. The majority of these studies pooled data from early trials using different strategies such as "de novo" combination of the high dose mTOR inhibitors with standard dose of CNI or high dose mTORi combined with mycophenolate. The large heterogeneity of these initial exploratory studies, many of them no longer in use, turns difficult any comparison with a well-defined standard of care regimen. The new strategies using concentration controlled reduced exposure of mTORi and CNI or early conversion from CNI to mTORi use have shown comparable patient and graft survival. Nevertheless, considering the central role of mTOR in health and disease states, more research is necessary to mitigate the adverse events and to explore further the potential beneficial effects of mTOR inhibitors.Sociedade Brasileira de Nefrologia2017-03-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002017000100070Brazilian Journal of Nephrology v.39 n.1 2017reponame:Jornal Brasileiro de Nefrologiainstname:Sociedade Brasileira de Nefrologia (SBN)instacron:SBN10.5935/0101-2800.20170012info:eu-repo/semantics/openAccessAndrade,Luis Gustavo Modelli deTedesco-Silva,Helioeng2017-03-22T00:00:00Zoai:scielo:S0101-28002017000100070Revistahttp://www.bjn.org.br/ONGhttps://old.scielo.br/oai/scielo-oai.php||jbn@sbn.org.br2175-82390101-2800opendoar:2017-03-22T00:00Jornal Brasileiro de Nefrologia - Sociedade Brasileira de Nefrologia (SBN)false |
dc.title.none.fl_str_mv |
Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors |
title |
Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors |
spellingShingle |
Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors Andrade,Luis Gustavo Modelli de mortality kidney transplantation serine-threonine kinases sirolimus |
title_short |
Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors |
title_full |
Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors |
title_fullStr |
Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors |
title_full_unstemmed |
Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors |
title_sort |
Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors |
author |
Andrade,Luis Gustavo Modelli de |
author_facet |
Andrade,Luis Gustavo Modelli de Tedesco-Silva,Helio |
author_role |
author |
author2 |
Tedesco-Silva,Helio |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Andrade,Luis Gustavo Modelli de Tedesco-Silva,Helio |
dc.subject.por.fl_str_mv |
mortality kidney transplantation serine-threonine kinases sirolimus |
topic |
mortality kidney transplantation serine-threonine kinases sirolimus |
description |
Abstract Registry studies and systematic reviews have shown higher risk for mortality and graft loss in patients in use of mTOR inhibitors (mTORi) compared to calcineurin-based (CNI) immunosuppressive regimens. The majority of these studies pooled data from early trials using different strategies such as "de novo" combination of the high dose mTOR inhibitors with standard dose of CNI or high dose mTORi combined with mycophenolate. The large heterogeneity of these initial exploratory studies, many of them no longer in use, turns difficult any comparison with a well-defined standard of care regimen. The new strategies using concentration controlled reduced exposure of mTORi and CNI or early conversion from CNI to mTORi use have shown comparable patient and graft survival. Nevertheless, considering the central role of mTOR in health and disease states, more research is necessary to mitigate the adverse events and to explore further the potential beneficial effects of mTOR inhibitors. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-03-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002017000100070 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002017000100070 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.5935/0101-2800.20170012 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Nefrologia |
publisher.none.fl_str_mv |
Sociedade Brasileira de Nefrologia |
dc.source.none.fl_str_mv |
Brazilian Journal of Nephrology v.39 n.1 2017 reponame:Jornal Brasileiro de Nefrologia instname:Sociedade Brasileira de Nefrologia (SBN) instacron:SBN |
instname_str |
Sociedade Brasileira de Nefrologia (SBN) |
instacron_str |
SBN |
institution |
SBN |
reponame_str |
Jornal Brasileiro de Nefrologia |
collection |
Jornal Brasileiro de Nefrologia |
repository.name.fl_str_mv |
Jornal Brasileiro de Nefrologia - Sociedade Brasileira de Nefrologia (SBN) |
repository.mail.fl_str_mv |
||jbn@sbn.org.br |
_version_ |
1752122064241688576 |