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Review Int J Mol Sci
. 2022 Jul 12;23(14):7707. doi: 10.3390/ijms23147707.
Medical Aspects of mTOR Inhibition in Kidney Transplantation
Elena Cuadrado-Payán 1, Fritz Diekmann 1 2 3, David Cucchiari 1 2
Affiliations expand
PMID: 35887051 PMCID: PMC9322634 DOI: 10.3390/ijms23147707
Free PMC article
Abstract
The advances in transplant immunosuppression have reduced substantially the incidence of kidney graft rejection. In recent years, the focus has moved from preventing rejection to preventing the long-term consequences of long-standing immunosuppression, including nephrotoxicity induced by calcineurin inhibitors (CNI), as well as infectious and neoplastic complications. Since the appearance in the late 1990s of mTOR inhibitors (mTORi), these unmet needs in immunosuppression management could be addressed thanks to their benefits (reduced rate of viral infections and cancer). However, management of side effects can be troublesome and hands-on experience is needed. Here, we review all the available information about them. Thanks to all the basic, translational and clinical research achieved in the last twenty years, we now use mTORi as de novo immunosuppression in association with CNI. Another possibility is represented by the conversion of either CNI or mycophenolate (MPA) to an mTORi later on after transplantation in low-risk kidney transplant recipients.