Current immunosuppressive treatment after kidney transplantation

Area of Science:

• Organ transplantation
• Immunosuppressive therapy
• Nephrology

Background:

• Multiple immunosuppressive drugs, including tacrolimus, mycophenolate, and mTOR-inhibitors, have been available since 1995.
• Physicians now have a range of choices for immunosuppressive therapy in organ transplantation.

Purpose of the Study:

• To review current immunosuppressive drugs used in kidney transplantation.
• To discuss evidence for selecting calcineurin inhibitors, antiproliferative agents, and induction therapy.
• To briefly discuss novel immunosuppressive agents.

Main Methods:

• Systematic review of studies on immunosuppressive drugs in kidney transplantation.
• Analysis of evidence for drug selection in post-transplant care.
• Literature search covering the last three decades.

Main Results:

• Calcineurin inhibitors (CNIs) are highly effective in preventing acute rejection, particularly in de novo kidney transplant recipients.
• Combination therapy with CNIs and mycophenolate or mTOR-inhibitors allows for reduced CNI doses, thereby mitigating nephrotoxicity.
• Current treatment guidelines offer a framework but necessitate individual patient-specific adjustments.

Conclusions:

• CNIs remain a cornerstone of maintenance immunosuppression to prevent acute rejection in kidney transplant patients.
• Combination strategies enhance efficacy and reduce CNI-related side effects, such as nephrotoxicity.
• Further long-term studies are required to establish optimal maintenance immunosuppressive regimens.