[Perspectives of immunosuppressive therapy in kidney transplantation]

Within recent years important progress has been made in the field of renal transplantation, both in terms of surgery and immunosuppression. At the present time renal transplantation offers a better expectation and quality of life to patients with end stage renal disease, compared with patients in dialysis. The survival of renal transplantation depends on many immunological and non immunological factors. The widespread use of calcineurine inhibitors (cyclosporine and tacrolimus) has improved the actuarial survival of transplanted kidneys at one year, decreasing the number and the severity of acute rejection episodes, but the calcineurine inhibitors did not improve the chronic rejection. The use of the new immunosuppressant drugs (mycophenolate mofetil, rapamicine and RAD, anti CD25 humanized antibodies) has contributed both to a further reduction of the number of rejection episodes and of side-effects of the immunosuppressant drugs, which have been possible thanks to the various combinations of these drugs. moreover these drugs allow the reduction or withdraw of steroids. Further studies will be necessary to ascertain that these new drugs improve the long term survival of transplanted kidneys and to define more precisely problems relating to the immunosuppressive therapy with respect to renal function, rejection, and patients' quality of life.