PMID- 26915834
OWN - NLM
STAT- MEDLINE
DCOM- 20161021
LR  - 20170103
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 48
IP  - 1
DP  - 2016 Jan-Feb
TI  - Sirolimus-Based Immunosuppressive Regimens in Renal Transplantation: A Systemic
      Review.
PG  - 3-9
LID - 10.1016/j.transproceed.2016.01.002 [doi]
LID - S0041-1345(16)00003-8 [pii]
AB  - Sirolimus (SRL)-based immunosuppressive regimens have been used for preventing
      rejection after kidney transplantation. This review analyzes their merits and
      demerits compared with other conventional regimes from the aspects of acute
      rejection rate, graft function, as well as patient/graft survival rates. In
      general, SRL is mostly recommended to be used as conversion therapy from
      calcineurin inhibitor (CNI) after kidney transplantation in most studies.
      Minimization or withdrawal of cyclosporine A (CsA) could also be considered when 
      it was combined with SRL. SRL can replace mycophenolate mofetil (MMF), and the
      CNI dose should be reduced appropriately in this setting. Quadruple maintenance
      regimens containing SRL need future study to clarify their superiority. De novo
      use of low-dose CNI combined with SRL has no apparent merits and thus is not
      recommended. De novo use of standard-dose CNI combined with SRL followed by
      maintenance, de novo use of CNI-free regimens, as well as SRL use in delayed
      graft function (DGF) patients who spare antibody induction and postpone CNI
      administration should also be avoided. SRL supports steroids withdrawal after
      kidney transplantation, and SRL combined with tacrolimus is recommended in this
      setting. Loading dose is recommended when initiating SRL treatment and its trough
      blood level should be routinely monitored.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Zhao, D Q
AU  - Zhao DQ
AD  - Kidney Transplantation Department, The Third Affiliated Hospital of Sun Yat-sen
      University, Guangzhou, China.
FAU - Li, S W
AU  - Li SW
AD  - Kidney Transplantation Department, The Third Affiliated Hospital of Sun Yat-sen
      University, Guangzhou, China.
FAU - Sun, Q Q
AU  - Sun QQ
AD  - Kidney Transplantation Department, The Third Affiliated Hospital of Sun Yat-sen
      University, Guangzhou, China. Electronic address: sunqiquan@hotmail.com.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (Calcineurin Inhibitors)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Steroids)
RN  - 83HN0GTJ6D (Cyclosporine)
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - W36ZG6FT64 (Sirolimus)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Adult
MH  - Calcineurin Inhibitors/therapeutic use
MH  - Cyclosporine/therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Graft Rejection/immunology/*prevention & control
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - *Kidney Transplantation
MH  - Male
MH  - Mycophenolic Acid/analogs & derivatives/therapeutic use
MH  - Postoperative Period
MH  - Sirolimus/*therapeutic use
MH  - Steroids/therapeutic use
MH  - Tacrolimus/therapeutic use
MH  - Treatment Outcome
EDAT- 2016/02/27 06:00
MHDA- 2016/10/22 06:00
CRDT- 2016/02/27 06:00
PHST- 2015/11/21 00:00 [received]
PHST- 2015/12/24 00:00 [revised]
PHST- 2016/01/05 00:00 [accepted]
PHST- 2016/02/27 06:00 [entrez]
PHST- 2016/02/27 06:00 [pubmed]
PHST- 2016/10/22 06:00 [medline]
AID - S0041-1345(16)00003-8 [pii]
AID - 10.1016/j.transproceed.2016.01.002 [doi]
PST - ppublish
SO  - Transplant Proc. 2016 Jan-Feb;48(1):3-9. doi: 10.1016/j.transproceed.2016.01.002.