ABSTRACT
Calcineurin inhibitors are one of the most common drugs used for prevention of acute rejection in recipients of renal allografts. New immunosuppressors have reduced the incidence of acute renal allograft rejection. There have been numerous recent attempts to develop alternative patterns of immunosuppressors for prevention of chronic renal allograft failure, and enhancing its survival. We described a patient who developed numerous complications after the initial postransplant period. He was treated with a calcineurin inhibitors-free immunosuppression in order to avoid nephrotoxicity, but had over 30 ng/ml of sirolimus. Renal function was impaired after cyclosponne withdrawal. Sirolimus was used in association with mycofenolate mofetil and prednisone.
Subject(s)
Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Mycophenolic Acid/analogs & derivatives , Adult , Calcineurin Inhibitors , Comorbidity , Cyclosporine/adverse effects , Drug Therapy, Combination , Fever/etiology , Glomerulosclerosis, Focal Segmental/complications , Glomerulosclerosis, Focal Segmental/surgery , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Kidney Diseases/chemically induced , Male , Mycophenolic Acid/administration & dosage , Mycophenolic Acid/therapeutic use , Prednisone/administration & dosage , Prednisone/therapeutic use , Pyelonephritis/etiology , Recurrence , Sirolimus/administration & dosage , Sirolimus/therapeutic use , Ureteral Diseases/etiology , Urinary Bladder Fistula/etiology , Urinary Fistula/etiologyABSTRACT
La mayoría de las pautas inmunosupresoras fueron diseñadas para disminuir la incidencia de rechazo agudo. Con la disminución de las tasas de rechazo agudo, tras la aparición de nuevos inmunosupresores en la década de los noventa, el objetivo en el futuro es disminuir la nefropatía crónica del injerto, aumentando su supervivencia. A continuación presentamos un paciente trasplantado renal que en el post-trasplante reciente se decidió, con el fin de evitar la nefrotoxicidad, utilizar una pauta inmunosupresora sin anticalcineurínicos. Durante un período de tiempo presentó niveles por encima de 30 ng/ml. Existe, por ahora, poca experiencia en el empleo de sirolimus en asociación con Micofenolato mofetil y prednisona, en el post-trasplante inmediato (AU)
Calcineurin inhibitors are one of the most common drugs used for prevention of acute rejection in recipients of renal allografts. New immunosuppressors have reduced the incidence of acute renal allograft rejection. There have been numerous recent attempts to develop alternative patterns of immunosuppressors for prevention of chronic renal allograft failure, and enhancing its survival. We described a patient who developed numerous complications after the initial postransplant period. He was treated with a calcineurin inhibitors-free immunosuppression in order to avoid nephrotoxicity, but had over 30 ng/ml of sirolimus. Renal function was impaired after cyclosponne withdrawal. Sirolimus was used in association with mycofenolate mofetil and prednisone (AU)
