الفهرس 
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Abstract
Transplantation is the renal replacement therapy of choice for patients with end stage renal disease (ESRD). However, not all patients are suitable candidates for transplantation, and suitability is often determined by the risks of receiving graft versus the risks of not receiving a graft.
Immunosuppressive therapy after kidney transplantation is based on calcineurin inhibitors (CNI). In most cases CNI therapy is combined with mycophenolate and steroids. In spite of good short-term results this therapy is associated with long-term toxicities, graft loss and patient death. Therefore, alternative immunosuppressive strategies are needed that combine excellent efficacy with low incidences of long-term adverse outcome
The mammalian target of rapamycin (mTOR) inhibitor class of immunosuppressive drugs were introduced more than 15 years ago as a new opportunity to create selective antirejection therapy in solid organ transplantation. In particular, absence of early nephrotoxicity seemed to provide an important opportunity to minimize or replace the calcineurin inhibitor (CNI) drugs, which were plagued by progressive nephrotoxicity when administered at doses needed to prevent rejection.
The post-transplant period is associated with a wide range of complications, including cardiovascular (CV), metabolic, oncologic, infectious, immunological, surgical, osseous, and hematologic complications
The main results of the study revealed that:
There is no substantial variance among patients who received mTOR inhibitors regimen and those who received CN inhibitors regimen as regard the age, sex, smoking, BMI, and family history of CKD, educational level, causes for CKD. There were several causes for shifting from CNI to mTOR, but the most common one was CNI toxicity in 50.6% of overall causes of shifting.
Patients who received mTOR inhibitors regimen have statistically significant higher rate of rejection than those who received CN inhibitors regimen. The percentage of BPAR in m.TOR-I is 42.1% in comparison to 11.1% in CNI group with P-value <0.001. Patients who received mTOR inhibitors regimen have statistically significant higher rate of proteinuria (30.2% vs 1.7%), higher rate of thrombocytopenia (19.8% vs 1.7%), and lower rate of diabetes (4.7% vs 11.7%), lower rate of hypertension (3.8% vs 10.6%) and lower rate of malignancy (2.8% vs 8.9%) than those who received CN inhibitors regimen.
Regarding laboratory data; patients who received mTOR inhibitors regimen have statistically significant lower platelet count than those who received CN inhibitors regimen. Patients who received mTOR inhibitors regimen have statistically significant lower fasting blood glucose, lower ALT, lower AST, and higher urea, higher creatinine, higher total cholesterol, higher LDL, higher triglyceride and lower eGFR than those who received CN inhibitors regimen.
The switch from CNI to mTORi following kidney transplantation was associated with improved graft function and lower malignancy rates, according to a meta-analysis of 29 eligible RCTs that included 5,747 KTRs However, these results have not been replicated in subsequent studies. chronic allograft nephropathy did not differ substantially across groups, suggesting that the improvement in graft function following conversion may be predominantly attributed to variables other than structural improvement
Even though mTOR inhibitors have been around for a while, their use has decreased dramatically over the past decade, with just 1.9 percent of transplant patients receiving them in 2016, rising to 4.3 percent a year following transplantation. In order to get the highest therapeutic benefit for KTRs,
The combination of low-dose CNI (tacrolimus) and everolimus might be the decisive factor. However, the high dropout rate owing to unacceptable AEs, such as severe infections, mouth ulcers, proteinuria, anemia, leucopenia, thrombocytopenia, dyslipidemia, acne, diarrhoea, and edoema, may preclude the switch to mTORi treatment. All of the distinctions among the two groups were quite large. Therefore, it is crucial to weigh the potential benefits and risks of mTORi conversion for each individual kidney transplant recipient (KTR) throughout the clinical decision-making process
Previous research found that changing to sirolimus was associated with better short-term renal function, however no investigations were found that looked at everolimus.