Immunosuppressive minimisation with mTOR inhibitors and Belatacept

Diekmann F – mTOR inhibitors in combination with low–dose CNI offer good rejection rates and acceptable allograft function, however, de novo mTOR inhitibor–based treatment in combination with mycophenolate is not widely used due to higher acute rejection rates. Early conversion from a CNI to an mTOR inhibitor is a feasible option in selected patients with a slightly higher acute rejection rate, but equal or better GFR. Co–stimulation blockade has been proven to facilitate anti–rejection prophylaxis without CNI–associated side effects. Recently, the combination of an mTOR inhibitor and belatacept with lymphocyte–depleting antibody induction and without maintnenance steroids has been explored in two pilot studies with very low acute rejection rates, very good graft function and an acceptable side effect profile.