Calcineurin inhibitor minimization, withdrawal and avoidance protocols after kidney transplantation

Abstract

A nonquantitative summary of the current evidence suggests that calcineurin inhibitor (CNI) minimization and also CNI‐free protocols are safe and efficient when used after the initial 3 months post‐transplantation. In fact, the largest study so far showed that low‐dose CNI in combination with mycophenolate mofetil (MMF) and steroids performed better than standard dose cyclosporine A (CsA). If CsA is used in combination with a mammalian target of rapamycin‐Inhibitor (mTOR‐I) considerable dose reduction of both drugs is required. A better choice than using both drug groups in lower doses together may be the withdrawal of CsA from this combination after 3–12 months. Later withdrawals or conversions to an mTOR‐I failed to show additional benefit in terms of graft function or survival but caused less post‐transplant malignancies. With improved short‐ and medium‐term outcomes, this entity will become more of an issue. In fact, in some areas of the world, nowadays malignancies are the leading cause of death.