[Immunosuppression in kidney transplantation: a way between efficacy and toxicity]

Area of Science:

• Nephrology
• Transplantation Immunology

Background:

• Renal transplantation is the optimal treatment for end-stage renal disease (ESRD).
• Advances in immunosuppressive agents have reduced acute rejection and early graft loss.
• Long-term transplant survival has seen minimal improvement due to late complications and graft deterioration.

Purpose of the Study:

• To review the current landscape of immunosuppressive therapy in renal transplantation.
• To highlight the benefits and risks associated with induction and maintenance immunosuppression.
• To discuss factors influencing treatment protocols and long-term graft outcomes.

Main Methods:

• Review of current literature on renal transplantation and immunosuppressive strategies.
• Analysis of the components and objectives of induction and maintenance immunosuppressive therapy.
• Discussion of complications, toxicity profiles, and influencing factors in treatment selection.

Main Results:

• Immunosuppressive therapy significantly reduces acute rejection but does not proportionally improve long-term graft survival.
• Induction therapy provides intense immunosuppression for high-risk patients but increases risks of cytopenias and viral infections.
• Maintenance therapy typically involves a combination of drugs (e.g., calcineurin inhibitors, antimetabolites, steroids) to prevent rejection and minimize toxicity.

Conclusions:

• Despite advancements, late renal transplant failure is driven by patient mortality from complications and progressive graft dysfunction.
• Immunosuppressive regimens, while essential, are associated with increased risks of infections and cancer.
• Personalized treatment protocols considering donor-recipient characteristics and adapting to clinical changes are crucial for optimizing long-term transplant success.