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Mammalian Target of Rapamycin Inhibitors in Organ TransplantationMammalian Target of Rapamycin Inhibitors: An Unkept Promise

Anthony J. Langone, MD; J. Harold Helderman, MD
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From the Vanderbilt Transplant Center and the Department of Internal Medicine, Nashville, TN.

Correspondence to: J. Harold Helderman, MD, Vanderbilt University School of Medicine, 1161 21st Ave S, S-3305, Nashville, TN 37232-2372; e-mail: Hal.helderman@vanderbilt.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(3):734-737. doi:10.1378/chest.12-1247
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The initial enthusiasm for the advent of a potentially nonnephrotoxic immunosuppressant has been muted by data unmasking nephrotoxicity of mammalian target of rapamycin inhibitors, including renal podocyte injury resulting in proteinuria. Adverse reactions, including anemia, thrombocytopenia, hyperlipidemia, and especially diabetogenesis, have limited its use to niche indications such as prevention or amelioration of malignancy in organ transplant. The class seems to be best used to address malignancy in organ allograft recipients and as a first-line therapy in lymphangioleiomyomatosis.


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