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: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.5935/0101-2800.20170012 http://hdl.handle.net/11449/157555 |
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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Repositório Institucional da UNESP |
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Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitorsAnálise crítica da perda do enxerto e óbito em receptores de transplante renal tratados com inibidores da mTORmortalitykidney transplantationserine-threonine kinasessirolimusmortalidadeserina-treonina quinases TORsirolimotransplante de rimAbstract 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.Resumo Estudos de registro e revisões sistemáticas mostraram um aumento de mortalidade e perda do enxerto nos pacientes em uso dos inibidores da mTOR (imTOR) em comparação a regimes baseados nos inibidores de calcineurina (iCN). A maioria destes estudos reuniu dados de ensaios clínicos iniciais utilizando diferentes estratégias, tais como a combinação de novo de altas doses de imTOR com doses padrão de iCN ou altas doses de imTOR combinado com micofenolato. A grande heterogeneidade destes estudos exploratórios iniciais, muitos deles não mais em uso, tornam difícil qualquer comparação. As novas estratégias que utilizam a concentração controlada e reduziram a exposição tanto de imTOR quando de iCN mostraram sobrevida do paciente e enxerto comparáveis. No entanto, considerando o papel central dos imTOR nos estados de saúde e doença, é necessária mais investigação para mitigar os eventos adversos e explorar melhor seus potenciais efeitos benéficos.Universidade Estadual PaulistaUniversidade Federal de São PauloUniversidade Estadual PaulistaSociedade Brasileira de NefrologiaUniversidade Estadual Paulista (Unesp)Universidade Federal de São PauloAndrade, Luis Gustavo Modelli DeTedesco-silva, Helio2018-11-12T17:25:53Z2018-11-12T17:25:53Z2017-03-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article70-78application/pdfhttp://dx.doi.org/10.5935/0101-2800.20170012Brazilian Journal of Nephrology. Sociedade Brasileira de Nefrologia, v. 39, n. 1, p. 70-78, 2017.0101-2800http://hdl.handle.net/11449/15755510.5935/0101-2800.20170012S0101-28002017000100070S0101-28002017000100070.pdfSciELOreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengBrazilian Journal of Nephrologyinfo:eu-repo/semantics/openAccess2024-01-20T06:28:08Zoai:repositorio.unesp.br:11449/157555Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-01-20T06:28:08Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Critical analysis of graft loss and death in kidney transplant recipients treated with mTOR inhibitors Análise crítica da perda do enxerto e óbito em receptores de transplante renal tratados com inibidores da mTOR |
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 mortalidade serina-treonina quinases TOR sirolimo transplante de rim |
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.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) Universidade Federal de São Paulo |
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 mortalidade serina-treonina quinases TOR sirolimo transplante de rim |
topic |
mortality kidney transplantation serine-threonine kinases sirolimus mortalidade serina-treonina quinases TOR sirolimo transplante de rim |
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 2018-11-12T17:25:53Z 2018-11-12T17:25:53Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.5935/0101-2800.20170012 Brazilian Journal of Nephrology. Sociedade Brasileira de Nefrologia, v. 39, n. 1, p. 70-78, 2017. 0101-2800 http://hdl.handle.net/11449/157555 10.5935/0101-2800.20170012 S0101-28002017000100070 S0101-28002017000100070.pdf |
url |
http://dx.doi.org/10.5935/0101-2800.20170012 http://hdl.handle.net/11449/157555 |
identifier_str_mv |
Brazilian Journal of Nephrology. Sociedade Brasileira de Nefrologia, v. 39, n. 1, p. 70-78, 2017. 0101-2800 10.5935/0101-2800.20170012 S0101-28002017000100070 S0101-28002017000100070.pdf |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Brazilian Journal of Nephrology |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
70-78 application/pdf |
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 |
SciELO reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
_version_ |
1799965669815484416 |