There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
mTOR Inhibitors in Renal Transplant Patients
- mTOR inhibitors are not the first line treatment in renal transplant patients with impaired renal function due to several reasons:
- Higher rejection rate: The use of mTOR inhibitors has been associated with a higher rate of biopsy-proven acute rejection (BPAR) compared to other immunosuppressive agents 1.
- Immunosuppressive potency: While mTOR inhibitors have potent immunosuppressive properties, their use in high-immunological risk kidney transplant recipients is still debated due to the perceived increased risk of rejection 2.
- Post-transplant diabetes mellitus (PTDM): The inhibition of the mTOR pathway may contribute to the development of PTDM, a major clinical complication that can impact allograft survival and increase the risk of severe systemic comorbidities 3.
- The mechanisms of action of mTOR inhibitors, including the inhibition of cell growth and proliferation, may affect various downstream pathways, leading to adverse reactions and limiting their use as a first-line treatment 4, 5.
- The use of mTOR inhibitors in renal transplant patients requires careful consideration of the potential benefits and risks, including the risk of rejection, PTDM, and other adverse reactions, and should be individualized based on the patient's specific needs and risk profile 1, 2, 3.