Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida 32610–0224, USA.
Curr Opin Nephrol Hypertens. 2011 Nov;20(6):610-5. doi: 10.1097/MNH.0b013e32834b4343.
The utilization of calcineurin inhibitors (CNI) in kidney transplantation has dramatically improved short-term outcomes but significant gains in long-term outcomes have proved elusive. Nephrotoxicity is the major problem associated with CNIs and is responsible for the disappointing progress seen in long-term graft survival. In this review, we assess CNI efficacy as well as the latest strategies employed to limit long-term CNI nephrotoxicity.
Three CNI sparing strategies - CNI withdrawal, CNI avoidance, and CNI minimization - are evaluated with discussion of key studies such as the Efficacy Limiting Toxicity Elimination-Symphony and Spare-the-Nephron studies. Recent breakthroughs in transplant immunosuppression are discussed such as the BENEFIT and BENEFIT-EXT studies, which have led to the recent US Food and Drug Administratrion approval of belatacept, a novel T-cell costimulation blocker.
For now, CNIs remain the proven standard of care in modern immunosuppression. However, some novel agents may challenge the role CNIs play in kidney transplantation in the very near future.
钙调磷酸酶抑制剂（CNI）在肾移植中的应用显著改善了短期预后，但长期预后的显著改善仍难以实现。CNI 的主要问题是肾毒性，这也是长期移植物存活率令人失望的原因。在这篇综述中，我们评估了 CNI 的疗效，以及最新的限制 CNI 肾毒性的策略。
评估了三种 CNI 节约策略——CNI 停药、CNI 回避和 CNI 最小化，并讨论了 Efficacy Limiting Toxicity Elimination-Symphony 和 Spare-the-Nephron 等关键研究。还讨论了移植免疫抑制的最新突破，如 BENEFIT 和 BENEFIT-EXT 研究，这些研究导致了新型 T 细胞共刺激阻断剂贝拉西普最近获得美国食品和药物管理局的批准。
目前，CNI 仍然是现代免疫抑制治疗的标准。然而，一些新型药物可能在不久的将来挑战 CNI 在肾移植中的作用。
