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World J Transplant. Jun 24, 2013; 3(2): 7-25
Published online Jun 24, 2013. doi: 10.5500/wjt.v3.i2.7
Published online Jun 24, 2013. doi: 10.5500/wjt.v3.i2.7
Is it time to give up with calcineurin inhibitors in kidney transplantation?
Maurizio Salvadori, Elisabetta Bertoni, Department of Renal Transplantation, Careggi University Hospital, 50139 Florence, Italy
Author contributions: Salvadori M planned and wrote the paper, Bertoni E contributed to the collection and the analysis of the papers cited in the references; both authors supervised the final version of the manuscript.
Correspondence to: Maurizio Salvadori, MD, Professor, Department of Renal Transplantation, Careggi University Hospital, viale Pieraccini 15, 50139 Florence, Italy. maurizio.salvadori1@gmail.com
Telephone: +39- 55-597151 Fax: Fax: +39-55-597151
Received: December 17, 2012
Revised: April 17, 2013
Accepted: May 9, 2013
Published online: June 24, 2013
Processing time: 172 Days and 3.3 Hours
Revised: April 17, 2013
Accepted: May 9, 2013
Published online: June 24, 2013
Processing time: 172 Days and 3.3 Hours
Core Tip
Core tip: Calcineurin inhibitors (CNIs) based therapy is still a cornerstone in renal transplantation. Nevertheless, with the use of such drugs the long-term graft survival did not improve. Causes may be nephrotoxicity, underimmunesuppression or both. All the trials attempting to CNIs sparing have been examined, but nephrotoxicity doesn’t seem to be responsible for the lack of long-term improvement. In recent years emerged the problem of anti-human leukocyte antigen antibodies not adequately suppressed by the CNIs based therapy. New drugs are necessary, but the pipeline seems to be almost empty now. To date the only promising drug strategy is the co-stimulation blockade, whose four-year results are reported.