%0 Journal Article
%T Monoterapia m-TOR.: £¿Una buena elecci¨®n en trasplante renal?
%A Franco-Esteve
%A Antonio
%A Tordera
%A Diana
%A Sen
%A M. Luz De la
%A Jim¨¦nez
%A Luis
%A Mas
%A Patricio
%A Mu£¿oz
%A Carlos
%A Olivares
%A Jes¨²s
%J Nefrolog¨ªa (Madrid)
%D 2012
%I Scientific Electronic Library Online
%R 10.3265/Nefrologia.pre2012.Jun.11314
%X calcineurin inhibitors have reduced acute rejection rates and improved short-term graft survival, but without any improvement in long-term outcomes, since calcineurin inhibitors cause nephrotoxicity and death with a functioning graft. mtor inhibitors have antiproliferative and anti-angiogenic effects with no nephrotoxicity. these properties could improve patient and graft long-term survival rates in select transplant recipients. in addition, monotherapy always diminishes the rate of non-compliance in chronic patients. we examined the evolution of 47 low immunological risk kidney transplant recipients with mtor inhibitor monotherapy. the mean age was 45¡À10 years (range: 18-69 years), with 25 males y 22 females. we performed an immunological evaluation before and at 3 and 12 months after starting monotherapy by detection of donor-specific antibodies by microsphere cytometry and the determination of lymphocyte activity with production of atp by cd4+ t-lymphocytes activated by pha mitogen. we considered patients to be of low immunological risk when the patient had an atp production less than 520ng/dl and no history of acute rejection episode or donor-specific antibodies. initially, 5 patients received immunosuppression induction without calcineurin inhibitors (mycophenolate, prednisone, mtor inhibitors and anti-cd25), and 42 were converted to mtor inhibitors due to secondary effects of calcineurin inhibitors or malignancies. a total of 34 recipients had received sirolimus and 13 everolimus. eighteen out 47 patients (38.2%) received prednisone and 29 (61.7%) mycophenolate with mtor before starting monotherapy. the mean follow-up period after starting monotherapy was 46.9 months (95% ci: 38.8-55.0 months). at the end of the follow-up, 7 out of 47 recipients (11.5%) had to change immunosuppression without losing their grafts after 1 year, due to heavy proteinuria in 2 cases, pulmonary infection in 1, acute rejection in 1, hepatotoxicity in 1, vasculitis in 1 and a temporar
%K renal transplantation
%K low immunological risk
%K mtor inhibitor monotherapy.
%U http://scielo.isciii.es/scielo.php?script=sci_abstract&pid=S0211-69952012000700010&lng=en&nrm=iso&tlng=en