Early switch from calcineurin inhibitors to mtor inhibitors leads to improved renal graft function

Access through your institution Buy or subscribe Calcineurin inhibitors such as tacrolimus and ciclosporin are widely used as immunosuppressants in renal transplantation, but are associated

with nephrotoxic effects and gradual deterioration of renal function. Some studies have indicated that the early conversion from calcineurin inhibitors to mTOR inhibitors might be associated

with improved renal function; however, results from other studies have been conflicting, and adverse events associated with mTOR inhibitors have been a concern. The ZEUS investigators note

that many of the adverse events associated with mTOR inhibitor use are at least partly dose-dependent and that an important challenge is to achieve sufficient efficacy while ensuring good

tolerability. Their study was designed to investigate whether elimination of calcineurin inhibitors 4.5 months after renal transplantation, by switching to everolimus plus mycophenolate

sodium, was associated with equivalent safety and efficacy but improved renal function as compared with continuation on ciclosporin and mycophenolate sodium. Between June 2005 and September

2007 the researchers enrolled 503 patients (aged 18–65 years) who had received _de novo_ kidney transplants at one of 17 transplant centers in Germany and Switzerland. Initially, patients

received basiliximab induction treatment, ciclosporin, enteric-coated mycophenolate sodium, and corticosteroids. About 4.5 months after transplantation, 300 patients were randomly assigned

to either continue on ciclosporin or to undergo stepwise elimination of calcineurin inhibitors by introduction of everolimus (0.75 mg twice daily). All patients remained on corticosteroids

and mycophenolate sodium and were followed up for 12 months after transplantation. This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your

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our FAQs * Contact customer support ORIGINAL RESEARCH PAPER * Budde, K. _ et al_. Everolimus-based, calcineurin-inhibitor-free regimen in recipients of _de-novo_ kidney transplants: an

open-label, randomised, controlled trial. _Lancet_ 377, 837–847 (2011) Article  CAS  Google Scholar  Download references Authors * Rebecca Ireland View author publications You can also

search for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Ireland, R. Early switch from calcineurin inhibitors to

mTOR inhibitors leads to improved renal graft function. _Nat Rev Nephrol_ 7, 243 (2011). https://doi.org/10.1038/nrneph.2011.36 Download citation * Published: 27 April 2011 * Issue Date: May

2011 * DOI: https://doi.org/10.1038/nrneph.2011.36 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link

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