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Table 3 Possible indications and disadvantages

From: Practical considerations for the use of mTOR inhibitors

Treatment regimen Patients who might benefit Disadvantages
De novo mTOR-I-based without CNI - Low immunological risk patients - Wound-healing problems in obese patients
- CNI-related side effects to be anticipated (neurotoxicity, nephrotoxicity, CNI-associated hemolytic uremic syndrome) - High incidence of side effects of mTOR-I and mycophenolate combination
- Patients at risk of CMV or BKV infection - Probably induction with lymphocyte-depleting antibodies necessary
- Patients at risk of post-transplant malignancy  
De novo mTOR-I and CNI combination - Low and intermediate immunological risk patients - Wound-healing problems in obese patients
- Patients who do not tolerate an adequate dose of mycophenolate - Possible risk of new-onset diabetes
- Patients at risk of CMV or BKV infection  
- Patients at risk of post-transplant malignancy