[Review of clinical trials on minimization and interruption of calcineurin inhibitors (CNIs) and protocols without CNIs in the transplantation of different organs (kidney, heart, and liver)].

Immunosuppressive therapy with calcineurin inhibitors (CNI) must be continued during the weeks following transplant to avoid acute rejection. Over the long-term, however, nephrotoxicity and morbidity induced by CNIs have a negative impact on patient and transplant survival. Therefore, for any organ, it is crucial to free patients from the nephrotoxicity associated with CNIs without risking under-immunosuppression and while maintaining good overall tolerance. For kidney transplants, minimization of CNI use in association with mycophenolate seems to be relatively safe and allows for improved kidney function without an added risk of rejection. The strategy of making a complete switch from CNIs to proliferation signal inhibitors (PSI) also seems to be promising. In patients with chronic allotransplant dysfunction, reduction of CNI doses by 30 to 50% in association with MPA seems to be safe and effective and replacement of CNIs with PSIs is pertinent, though limited by their effect on proteinuria. For liver transplants, late and minimal introduction of CNIs under induction seems to be safe and effective for the preservation of kidney function, especially when precarious. For heart transplants, preliminary studies conducted on a small number of patients suggest that delayed introduction of CNIs at minimal doses and late elimination of the therapy are safe after transplant.