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Related Experiment Videos

Renal transplantation: basic concepts and evolution of therapy.

William E Braun1

  • 1Department of Nephrology and Hypertension, Consultant Organ Transplantation, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. braunw@ccf.org

Journal of Clinical Apheresis
|October 22, 2003
PubMed
Summary

Recent advances in renal transplantation have reduced acute cellular rejection but increased antibody-mediated rejection. New immunosuppressants and protocols aim to minimize toxicity and manage complex rejection cases effectively.

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Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Pharmacology

Background:

  • Renal transplantation has seen significant changes in rejection patterns and immunosuppressant strategies over the past five years.
  • Hyperacute rejection is now rare, and acute cellular rejection rates have decreased to approximately 10% within the first year.
  • Humoral/antibody-mediated rejection has emerged as a more prominent challenge in kidney allograft recipients.

Purpose of the Study:

  • To review the evolving landscape of renal transplantation, focusing on shifts in rejection types and immunosuppressive therapies.
  • To highlight advancements in managing acute cellular and antibody-mediated rejection.
  • To discuss novel immunosuppressive agents and treatment protocols being investigated.

Main Methods:

Related Experiment Videos

  • Review of recent literature and clinical practice changes in renal transplantation.
  • Analysis of the impact of various immunosuppressants, including calcineurin inhibitors, mycophenolate mofetil, sirolimus, and monoclonal antibodies.
  • Examination of emerging therapeutic strategies like calcineurin-free regimens, glucocorticoid avoidance, and apheresis.

    • Main Results:

    • Significant reduction in acute cellular rejection attributed to optimized calcineurin inhibitor use, increased mycophenolate mofetil, and sirolimus introduction.
    • Development of potent antibody-based therapies (antithymocyte globulin, anti-CD25 antibodies) contributing to improved allograft survival.
    • Increased prevalence of antibody-mediated rejection necessitates alternative management strategies.

    Conclusions:

    • Current immunosuppressive protocols are effective in reducing acute cellular rejection but require adaptation for antibody-mediated rejection.
    • Novel calcineurin-free and glucocorticoid-sparing protocols are under investigation to mitigate long-term toxicities.
    • Apheresis and new agents like FTY720 and Campath-1 show promise in managing complex rejection scenarios and post-transplant complications.