Kidney Transplantation: Advances in Immunosuppression

The past decade has witnessed the introduction of several new immunosuppressive agents. The availability of these new agents has led to attempts to determine which is the best combination of maintenance immunosuppression for the patients, based on efficacy and reduction of adverse effects. Steroid avoidance, withdrawal and minimization regimens are being assessed. Calcineurin withdrawal or minimization protocols are studied in an attempt to improve long term allograft function and survival. Immunosuppression regimens are no longer standard and are tailored to the patient’s needs depending on risk profiles and benefits. The introduction of interleukin-2 receptor antibody inhibitors has further reduced the risk of acute rejections without any increase in the adverse profiles. Newer biologicals such as alemtuzumab and belatacept may allow the use of lower doses of immunosuppressive agent immediately posttransplant. The use of rituximab in combination with other measures has extended the frontiers of kidney transplantation to ABO and conventional crossmatch incompatible transplants.