Calcineurin inhibitor sparing in renal transplantation

Purpose of review The aim of this review is to report on the current state of calcineurin inhibitor-sparing therapies. The influence of mammalian target of rapamycin inhibitors in combination with low-dose or no calcineurin in hibitors on long-term allograft survival and function are discussed. Calcineurin inhibitor-sparing therapies without mammalian target of rapamycin inhibitors are also discussed. Recent findings The withdrawl of calcineurin inhibitors 3 months after transplantation and continuous therapy with sirolimus and prednisolone gives an adequate long-term allograft survival rate 4 years after transplantation. Low-dose calcineurin inhibitors together with everolimus seems to be superior to a full-dose calcineurin inhibitor-based therapy 3 years after transplantation, but adequately powered studies with hard endpoints are still needed. If mammalian target of rapamycin inhibitors are not tolerated (up to 30% of patients), other strategies such as antimetabolite (mycophenolate mofetil, azathioprine)-based therapy or antibody therapies (that is beletacept) may be utilized to facilitate calcineurin inhibitor withdrawl. Summary New immunosuppressive regimens have made it possible to withdraw or completely avoid cyclosporine or tacrolimus in selected patients at high risk of chromic allograft nephropathy and calcineurin inhibitor toxity.