XXXX in kidney transplant recipients. Safety issues and timing of discontinuation.

@entity1 @entity228 @entity177 @entity205 @entity134 @entity230 @entity65 @entity288
@entity288 have played a key role in the immunosuppression of organ transplantation. Unfortunately, the extensive use of these agents has resulted in disabling and life-threatening adverse effects in many @entity1 . The advent of concomitant @entity228 / @entity205 regimens has allowed a reduction in the dosages of @entity230 administered, yet @entity134 -induced morbidity is still a major problem in many @entity205 -treated renal transplant @entity1 . After favourable initial experiences with @entity205 monotherapy, several attempts at @entity134 -free immunosuppression in renal transplant @entity1 have been undertaken, either by not starting @entity230 after transplantation or by stopping @entity230 in @entity1 with stable graft function. Most controlled and uncontrolled trials showed that with either strategy short term graft survival was similar with or without @entity230 , but acute rejection was more frequent in @entity1 not taking @entity230 . The percentage of @entity1 who could be maintained @entity134 -free ranged from 28 to 94%, and was higher in @entity1 who stopped @entity230 later than in those never receiving them. Little information is available about long term follow-up of these @entity1 . Some studies reported late @entity177 in @entity1 not taking @entity230 , while others reported a favourable outcome even in the long term. @entity134 -free immunosuppression is feasible in renal transplant @entity1 , but it requires careful monitoring of renal function and @entity205 dosage. This strategy is particularly indicated in @entity1 at high risk of @entity65 or @entity134 -related complications, and in @entity1 . Nevertheless, several issues need to be better elucidated by further studies, namely the long term outcome of @entity134 -free immunosuppression, the advantages and disadvantages of @entity134 avoidance versus @entity134 withdrawal, and the criteria for selecting @entity1 .
