Maintenance immunosuppressive therapy in adult renal transplantation: a single center analysis

In the present study we have analyzed the maintenance immunosuppression of renal transplant patients followed at the Medical University of Vienna. Since more than thousand renal transplant patients are registered and treated at this center, our data reveal the pattern as well as the current and past practices of the prescription of immunosuppressive drugs in a large outpatient setting. The majority of patients displayed a transplant vintage of more than 5 years and used calcineurin inhibitors (CNIs), and/or steroids and/or antimetabolites reflecting the general prescription profile of immunosuppressive drugs in renal transplant recipients. However, the selection of immunosuppressive combinations as well as the dynamics of the immunosuppressive regimen in the life of the stable allograft recipient - minimization, conversion and/or withdrawal of one or more of each of the drugs - are not founded on strong data derived from adequately powered clinical trials but rather follows a mixture of various smaller and medium-sized clinical studies and the individual center attitude based on mostly center-specific uncontrolled clinical observations. Hence, the maintenance immunosuppression of transplant patients is the result of a strong empirical attitude and only adequately powered prospective trials may inform us which immunosuppressive regimen and overall strategy will be ideal for the individual renal transplant recipient.