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Pediatric Nephrology
Published in: Pediatric Nephrology 7/2014

01-07-2014 | Review

mTOR inhibitors in pediatric kidney transplantation

Authors: Lars Pape, Thurid Ahlenstiel

Published in: Pediatric Nephrology | Issue 7/2014

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Abstract

The mammalian target of the rapamycin (mTOR) inhibitors sirolimus and everolimus are increasingly being used in pediatric kidney transplantation in different combinations and doses. Several studies have shown beneficial effects of using mTOR inhibitors in children after pediatric renal transplantation. A switch to a low-dose calcineurin inhibitor (CNI) and mTOR inhibitor has been proven to stabilize the glomerular filtration rate. Additionally, de novo studies using a low-dose CNI and an mTOR inhibitor have shown good graft survival and a low number of rejections. Side effects of mTOR inhibitors, such as hyperlipidemia, wound healing problems, and proteinuria, mainly occur if high doses are given and if treatment is not combined with a CNI. Lower doses of mTOR inhibitors do not result in growth impairment or reduced testosterone levels. Treatment with mTOR inhibitors is also associated with a lower number of viral infections, especially cytomegalovirus. Due to their antiproliferative effect, mTOR inhibitors could theoretically reduce the risk of post-transplant lymphoproliferative disease. mTOR inhibitors, especially in combination with low-dose CNIs, can safely be used in children after kidney transplantation as de novo therapy or for conversion from CNI- and mycophenolate mofetil-based regimens.
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Metadata
Title
mTOR inhibitors in pediatric kidney transplantation
Authors
Lars Pape
Thurid Ahlenstiel
Publication date
01-07-2014
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 7/2014
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-013-2505-9

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