[Nephrology--Part 2. Strategies in the immunosuppression after kidney transplantation]

As a result of better prevention and treatment of acute rejection, 1-year kidney graft survival exceeds 90% in most centers. By contrast, the rate of attrition over the long-term did not change during the last decades. As current immunosuppressive agents lack specificity (infection, malignant disease), the search for the ideal immunosuppressive agent or drug combinations continues. The goal is to prevent chronic allograft nephropathy, toxicity, infections, malignancies, and metabolic problems. Long-term immunosuppression should be reliable and stable.

This article is aiming to discuss current strategies such as nephrotoxicity-free therapy, avoidance or withdrawal of steroids, therapy of acute rejection, and immunosuppressive therapy in high-risk patients.