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Review
. 2015 Dec 22;4(Suppl 1):6.
doi: 10.1186/s13737-015-0028-6. eCollection 2015.

Reviewing 15 years of experience with sirolimus

Helio Tedesco Silva Jr  1 , Claudia Rosso Felipe  1 , Jose Osmar Medina Pestana  1
Affiliations
Review

Reviewing 15 years of experience with sirolimus

Helio Tedesco Silva Jr et al. Transplant Res. .

Abstract

Here, we review 15 years of clinical use of sirolimus in our transplant center, in context with the developing immunosuppressive strategies use worldwide. The majority of studies were conducted in de novo kidney transplant recipients, using sirolimus (SRL) in combination with calcineurin inhibitors (CNIs). We also explored steroid (ST) or CNI-sparing therapies, including CNI minimization, elimination, or conversion strategies in combination with mycophenolate (MMF/MPS). Pooled long-term outcomes were comparable with those obtained with CNI and antimetabolite combination. Surprisingly, there are still several areas that need further investigation to improve the risk/benefit profile of SRL in kidney transplantation, including pharmacokinetic/pharmacodynamic drug-to-drug interaction with cyclosporine (CsA) or tacrolimus (TAC), mechanisms of SRL-associated adverse reactions and combinations with other drugs such as belatacept and once-daily TAC, possibly leading to improved long-term adherence. These studies, along with others investigating the benefits of SRL associated lower viral infections and malignancies, are essential as we do not expect the introduction of new immunosuppressive drugs in the near future.

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References

    1. Machado PG, Felipe CR, Hanzawa NM, Park SI, Garcia R, Alfieri F, et al. An open-label randomized trial of the safety and efficacy of sirolimus vs. azathioprine in living related renal allograft recipients receiving cyclosporine and prednisone combination. Clin Transplant. 2004;18:28–38. doi: 10.1111/j.1399-0012.2004.00113.x. - DOI - PubMed
    1. Kahan BD. Efficacy of sirolimus compared with azathioprine for reduction of acute renal allograft rejection: a randomised multicentre study. The Rapamune US Study Group. Lancet. 2000;356 (9225):194–202. England. - PubMed
    1. MacDonald AS. A worldwide, phase III, randomized, controlled, safety and efficacy study of a sirolimus/cyclosporine regimen for prevention of acute rejection in recipients of primary mismatched renal allografts. Transplantation. 2001;71:271–80. doi: 10.1097/00007890-200101270-00019. - DOI - PubMed
    1. Machado PG, Felipe CR, Park SI, Garcia R, Moreira S, Casarini D, et al. Preservation of graft function in low-risk living kidney transplant recipients treated with a combination of sirolimus and cyclosporine. Braz J Med Biol Res. 2004;37 (9):1303–12. Brazil. - PubMed
    1. Medina-Pestana JO, Sampaio EM, Vaz ML, Pinheiro-Machado PG, Tedesco-Silva Jr H. Worse renal transplant outcomes observed among Afro-Brazilian patients on prospective registry data of 2461 renal transplants at least 1 year follow-up. Transplant Proc. 2007;39(2):435–6. United States. - PubMed

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