Sirolimus, which has a distinctive mechanism of action that inhibits cytokine-driven cell proliferation and maturation, provides an exciting addition to the immunosuppressive regimen for organ transplantation. A significant decrease in the number and severity of rejection episodes has been noted when sirolimus is used; it also offers the potential for patients to be withdrawn from steroids, making kidney transplantation an option for many more potential recipients. Toxic conditions such as hyperlipidemia, thrombocytopenia, and leukopenia become transient and manageable with reduction of the sirolimus dose and/or countermeasure therapy.
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References
1.
StepkowskiSKahanBD. Synergistic activity of the triple combination: Cyclosporine, rapamycin, and brequinar. Transplant Proc.1993;25:29–31.
2.
KahanBD. The role of rapamycin in chronic rejection prophylaxis: A theoretical consideration. Graft.1998;1:93–96.
KunzJHenriquezRSchneiderUDeuter-ReinhardMMovvaNRHallMN. Target of rapamycin in yeast, TOR2, is essential phosphatidylinositol kinase homolog required for G1 progression. Cell.1993;73:585–586.
5.
KellyPGruberSBehbodFKahanB. Sirolimus, a new, potent immunosuppressive agent. Pharmacotherapy.1997;17:1148–1156.
6.
MurgiaMJordanSKahanBD. The side effect profile of sirolimus: A phase I study in quiescent cyclosporine-prednisone treated renal transplant patients. Kidney Int.1996;49:209–216.
7.
KahanBD. The potential role of rapamycin in pediatric transplantation as observed from adult studies. Ped Transplant.1999;3:1–7.
8.
KahanBD. Efficacy of sirolimus compared with azathioprine for reduction of acute renal allograft rejection: A randomised multicentre study. Lancet.2000;356:194–202.
