Büchler M
Service de Néphrologie et Immunologie Clinique, CHU Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, Tours, France.
Nephrol Ther. 2009 Dec;5 Suppl 6:S390-4. doi: 10.1016/S1769-7255(09)73431-5.
The choice of immunosuppression treatment in the kidney transplant patient depends on many factors: a history of cutaneous tumor; immunological, vascular, and primary cytomegalovirus infection risks; delay in the graft resuming function; patient knowledge of the side effects of immunosuppressant treatments, etc. Starting from a case study, this article describes the indications and contraindications of mTOR inhibitor use in the long-term immunosuppression strategy in the kidney transplantation patient. It also discusses the delay after grafting when the mTOR inhibitors can be introduced, immediately or at a later time, and points out some advantages of mycophenolate or calcineurin inhibitor substitution with mTOR inhibitors.
皮肤肿瘤病史；免疫、血管及原发性巨细胞病毒感染风险；移植肾功能恢复延迟；患者对免疫抑制治疗副作用的了解程度等。本文从一个病例研究出发，阐述了mTOR抑制剂在肾移植患者长期免疫抑制策略中的应用指征和禁忌证。还讨论了移植后何时可立即或稍后引入mTOR抑制剂，以及用mTOR抑制剂替代霉酚酸酯或钙调神经磷酸酶抑制剂的一些优势。
