[Immunosuppressive protocols in kidney transplantation: with or without induction?]

Area of Science:

• Nephrology
• Transplantation Immunology

Background:

• Kidney transplantation is the preferred treatment for end-stage kidney disease.
• Significant advancements in immunosuppressive drugs have improved transplant outcomes, particularly in preventing acute rejection.
• Cyclosporine's introduction in the 1980s led to the development of various immunosuppressive protocols.

Purpose of the Study:

• To review the evolution and strategies of immunosuppressive protocols in kidney transplantation.
• To evaluate the role of induction therapy in kidney transplant recipients.
• To discuss the factors influencing the choice between induction and non-induction protocols.

Main Methods:

• Review of established immunosuppressive protocols in kidney transplantation.
• Analysis of induction therapy agents, including polyclonal and monoclonal antibodies.
• Evaluation of immunological risk assessment for recipient stratification.

Main Results:

• Immunosuppressive protocols have evolved, with strategies including or excluding induction therapy.
• Induction therapies, using various antibody agents, have shown improved early results in preventing acute rejection.
• Non-induction protocols may be suitable for select kidney transplant candidates.

Conclusions:

• While induction therapy improves early outcomes, non-induction strategies are viable for certain patients.
• The optimal immunosuppressive protocol is not universally defined.
• Individualization of immunosuppressive treatment based on recipient risk is crucial for successful kidney transplantation.