Current use and future trends in induction therapy

Induction therapy has been utilized since the late 70s to reorient the immune system at the time of antigen presentation, decrease acute rejection and improve long-term graft survival. Currently, over 70% of patients undergoing kidney transplantation receive induction therapy. The current agents include OKT3, polyclonal antilymphocyte agents (Thymoglobulin being most frequently used), the anti-interleukin-2 receptor monoclonal antibodies daclizumab and basiliximab and Campath 1H. The current biologic agents are used for short-term therapy although their biologic effects may be prolonged. The next generation of induction agents is being developed for chronic use in calcineurin inhibitor-free and/or steroid-free regimens. These new biologic agents will be developed to simplify immunosuppression regimens, improve compliance and minimize long term toxicities.