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Related Experiment Videos

Renal transplantation, past, present and future.

C Ponticelli1, A Tarantino, A Vegeto

  • 1Division of Nephrology and Dialysis, IRCCS Ospedale Maggiore di Milano, Milan, Italy.

Journal of Nephrology
|February 25, 2000
PubMed
Summary

Immunosuppressive drugs have advanced kidney transplant survival rates significantly. Newer agents offer more targeted therapy, reducing rejection and enabling steroid-sparing protocols, though long-term side effects remain a concern.

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Area of Science:

  • Immunology
  • Transplantation Medicine
  • Pharmacology

Background:

  • Renal transplantation success has dramatically improved over 40 years due to evolving immunosuppressive strategies.
  • Early immunosuppression with glucocorticoids and azathioprine led to high rejection and infection rates.
  • Advances in molecular immunology have driven the discovery of more specific immunosuppressive agents.

Purpose of the Study:

  • To review the evolution of immunosuppressive drug regimens in renal transplantation.
  • To highlight the impact of new immunosuppressive agents on graft survival and rejection rates.
  • To discuss current challenges and future directions in immunosuppression, including the pursuit of immunological tolerance.

Main Methods:

  • Historical review of immunosuppressive drug development in transplantation.

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  • Analysis of clinical trial outcomes for various immunosuppressive regimens.
  • Discussion of emerging immunosuppressive agents and tolerance-inducing strategies.

    • Main Results:

    • Modern immunosuppression achieves 1-year graft survival of 80-90%, a significant improvement over historical methods.
    • Introduction of agents like cyclosporine and monoclonal antibodies improved rejection control.
    • Newer drugs (tacrolimus, rapamycin, mycophenolate mofetil) offer more selective T- and B-cell targeting.
    • Combination therapies and steroid-sparing protocols reduced acute rejection to <10%.

    Conclusions:

    • Current immunosuppression has transformed kidney transplantation into a routine procedure.
    • The primary challenge is managing long-term side effects of prolonged immunosuppression, such as infections and malignancies.
    • Future research focuses on achieving immunological tolerance to minimize immunosuppressive therapy and its associated risks.