Journal: Drug Invention Today

Article Id: JPRS-Pcol-00004469
Title: Calcineurin inhibitor old but gold: Mammalian target of rapamycin inhibitor versus calcineurin inhibitor as an immunosuppression regime combined with mycophenolate mofetil in kidney transplantation
Category: Pharmacology
Section: Research Article
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    Aim: The clinical experience of the mammalian target of rapamycin inhibitors in post kidney transplantation remains challenging even after more than 30 years of clinical studies. After these years, several studies using database registration data indicate that patients receiving mammalian target of rapamycin inhibitors (mTOR-I), as sirolimus (SRL), are at increased risk of acute rejection. Graft loss is increased compared to patients receiving cyclosporine (CSA) or tacrolimus (TAC) in combination with mycophenolate mofetil (MMF). Materials and Methods: A meta-analysis study research has performed in Nasr City Insurance Hospital and Nile Badrawi Hospital from September 2011 to September 2018 on the patients with renal transplantation who follow up with the team of transplantation. All patients were transplanted from an unrelated living donor and have zero PRA (no donor-specific antibody [DSA]) before transplantations. Results: We have excluded any comorbidities, risk of rejection as non-compliance with cytotoxic drugs, recurrent glomerular disease, patients have positive DSA before transplantation or already known with graft rejection before shifting from calcineurin inhibitor (CNI) to mTOR-I. We have followed those patients after transplantation, and all cases were transplanted at Nasr City Hospital and Nile Badrawi Hospital. We have classified the patient on two groups: Group I: On mTOR-I (SRL or everolimus) there were 658 patients. Group II: On CNI (cyclosporin or tacrolimus) there were 800 patients. The selection of group number one has depended on patients who have shifted from CNI to mTOR-I due to different causes. Our protocol of conversion from CNI to mTOR-I was: Six months after transplant and patients should be a low immunologic risk, have (eGFR) > 40 mL/min and no significant proteinuria (i.e., below 800 mg/day). The causes of shifting from CNI to mTOR-I were different, but CNI toxicity was the leading cause and diagnosed by biopsy. The group of mTOR-I showed a significant increase in the rate of biopsy proved acute rejection (41.8%) in comparison with the group of CNI which showed less incidence of biopsy-proven acute rejection (11.1%). Conclusion: CNI-based immunosuppression remains the cornerstone of our current immunosuppression protocols. The current mainstay immunosuppression protocol is the one used, i.e., antibody induction, low-dose CNI, MMF, and steroids avoid the use of mTOR-I de novo.

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    Author(s) Name:

    Hisham Mostafa Tawfik*

    Affiliation(s) Name:

    Department of Internal and Nephrology, Nephrology Unit, Minia University, Egypt

    *Corresponding author: Hisham Mostafa Tawfik, Department of Internal and Nephrology, Nephrology Unit, Minia University, Egypt

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    Author:

    Hisham Mostafa Tawfik*

    Title:Calcineurin inhibitor old but gold: Mammalian target of rapamycin inhibitor versus calcineurin inhibitor as an immunosuppression regime combined with mycophenolate mofetil in kidney transplantation
    Journal:Drug Invention Today
    Vol(issue):12 (November )
    Year:2019
    Page No: (2713-2716)
  • Experimental Methods Keywords

    Methodology:A meta-analysis study,patients with renal transplantation
    Research Materials:mycophenolate mofetil (MMF)

Keywords

Calcineurin inhibitor Mammalian target of rapamycin inhibitor Mycophenolate mofetil

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