Target of rapamycin inhibitors (TOR-I; sirolimus and everolimus) for primary immunosuppression in kidney transplant recipients

Kidney transplantation is the treatment of choice for most patients with end‐stage renal disease (ESRD). Strategies to increase donor organ availability and to prolong the transplanted kidney's survival have become priorities in kidney transplantation. This review aimed to evaluate the short and long‐term benefits and harms of sirolimus and everolimus (TOR‐I) when used in primary immunosuppressive regimens for kidney transplant recipients. Thirty three trials investigating the use of TOR‐I in four different settings were evaluated in this review. No differences in the hard‐end points of patient and graft survival were demonstrated for or against TOR‐I in any comparison. Generally surrogate endpoints for graft survival favour TOR‐I (lower risk of acute rejection and higher GFR) and surrogate endpoints for patient outcomes are worsened by TOR‐I (bone marrow suppression, lipid disturbance). Long‐term hard‐endpoint data from methodologically robust randomised trials are still needed.