[Current trends in renal transplant immunosuppression]

Several new immunosuppressives have been introduced in renal transplantation during the past decade. Mycophenolate mofetil, tacrolimus, cyclosporine microemulsion, sirolimus, monoclonal and polyclonal antibodies have all contributed to decreasing the rate of acute rejection. However, a more intense immnuosuppression has resulted in an increased incidence of opportunistic infections and malignant diseases. The main cause of death in renal transplant recipients are cardiovascular diseases, and the majority of patients die with a functioning graft. Renal transplant recipients are at an increased risk of the development of cardiovascular diseases due to prolonged uremia and dialysis itself, combined with the proatherogenic effect of immunosuppressive drugs. Corticosteroids and calcineurin inhibitors are the main groups of drugs associated with an increased risk of atherosclerosis. The main challenge in the present and future treatment of transplanted patients is the establishment of an immunosuppressive protocol that will minimize or completely avoid proatherogenic immunosuppressives while preserving the low incidence of acute rejection.