Abstract
Advances in immunosuppression medications have led to significant improvement in renal transplantation outcomes over the past few decades. The introduction of cyclosporine in the 1980s resulted in a reduction of acute rejection rates and prolonged short-term graft survival. The use of induction immunosuppression agents combined with the development of new maintenance therapies have led to a further decrease in early rejection episodes, making allo-immune causes of early graft loss rare. Despite these advances, overall graft survival remains unchanged in recent years. Therapies for the treatment of rejection have evolved over time. Special populations within the transplant community may warrant tailored immunosuppressive therapy. The transplant team and patient are challenged with deliberating the risks and benefits of these immunosuppression medications. This chapter details current strategies, evidence, and risk profiles of immunosuppressive medications for kidney transplantation along with treatment and prevention of rejection.
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References
Hardinger KL, Koch MJ, Brennan DC. Current and future immunosuppressive strategies in renal transplantation. Pharmacotherapy. 2004;24:1159–76.
Hardinger KL. Selection of induction therapy. Transpl Int. 2013;26:662–72.
Gabardi S, Martin ST, Roberts KL, Grafals M. Induction immunosuppressive therapies in renal transplantation. Am J Health Syst Pharm. 2011;68:211–8.
Kahan BD. Reduction of the occurrence of acute cellular rejection. Transplantation. 1999;67:276–84.
Nashan B. Antibody induction therapy in renal transplant patients receiving calcineurin-inhibitor immunosuppressive regimens: a comparative review. BioDrugs. 2005;19:39–46.
Ponticelli C, et al. A randomized, double-blind trial of basiliximab immunoprophylaxis plus triple therapy in kidney transplant recipients. Transplantation. 2001;72(7):1261–7.
Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med. 2006;355:1967–77.
Hanaway MJ, Woodle ES, Mulgaonkar S, et al. Alemtuzumab induction in renal transplantation. N Engl J Med. 2011;364:1909–19.
3C Study Collaborative Group. Alemtuzumab – based induction treatment versus basiliximab – based induction treatment in kidney transplantation. Lancet. 2014;384:1684–90.
Bustami RT. Immunosuppression and the risk of post transplant malignancy. Am J Trans. 2004;4:87–93.
Caillard S. Posttransplant Lymphoproferative disorders. Transplantation. 2005;80:1233–43.
Kauffman HM, et al. Post-transplant de novo malignancies in renal transplant recipients: the past and present. Transplant Int. 2006;19(8):607–20.
Hall EC, et al. Association of Antibody Induction immunosuppression with cancer. Transplantation. 2015;99:5.
Beaty CA, Cymet T. Organ transplantation for the primary care provider: what you need to know to get your patient a new liver or kidney. Compr Ther. 2008;34:69–76.
Golshayan D, Buhler L, Lechler RI, Pascual M. From current immunosuppressive strategies to clinical tolerance of allografts. Transpl Int. 2007;20:12–24.
International Neoral Renal Transplantation Study Group. Cyclosporine microemulsion (Neoral) absorption profiling and sparse-sample predictors during the first 3 months after renal transplantation. Am J Transplant. 2002;2:148–56.
Chisholm MA, et al. Associations of characteristics of renal transplant recipients with clinicians’ perceptions of adherence to immunosuppressant therapy. Tranplantation. 2007;84(9):1145–50.
Mayer AD, Dmitrewski J, Squifflet JP, et al. Multicenter randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection: a report of the European Tacrolimus Multicenter Renal Study Group. Transplantation. 1997;64:436–43.
Azzi JR. Calcineurin inhibitors: 40 years later. J Immunol. 2013;191(12):5785–91.
Gabardi S, Tran JL, Clarkson MR. Enteric-coated mycophenolate sodium. Ann Pharmacother. 2003;37:1685–93.
Budde K, Durr M, Liefeldt L, Neumayer HH, Glander P. Enteric-coated mycophenolate sodium. Expert Opin Drug Saf. 2010;9:981–94.
Augustine JJ, Bodziak KA, Hricik DE. Use of sirolimus in solid organ transplantation. Drugs. 2007;67:369–91.
MacDonald AS. A worldwide, phase III, randomized, controlled, safety and efficacy study of a sirolimus/cyclosporine regimen for prevention of acute rejection in recipients of primary mismatched renal allografts. Transplantation. 2001;71:271–80.
Kreis H, Oberbauer R, Campistol JM, et al. Long-term benefits with sirolimus-based therapy after early cyclosporine withdrawal. J Am Soc Nephrol. 2004;15:809–17.
Ahsan N, Hricik D, Matas A, et al. Prednisone withdrawal in kidney transplant recipients on cyclosporine and mycophenolate mofetil–a prospective randomized study. Steroid Withdrawal Study Group. Transplantation. 1999;68:1865–74.
Liu CL, Fan ST, Lo CM, et al. Interleukin-2 receptor antibody (basiliximab) for immunosuppressive induction therapy after liver transplantation: a protocol with early elimination of steroids and reduction of tacrolimus dosage. Liver Transpl. 2004;10:728–33.
Laftavi MR, Stephan R, Stefanick B, et al. Randomized prospective trial of early steroid withdrawal compared with low-dose steroids in renal transplant recipients using serial protocol biopsies to assess efficacy and safety. Surgery. 2005;137:364–71.
Kaufman DB, Leventhal JR, Koffron AJ, et al. A prospective study of rapid corticosteroid elimination in simultaneous pancreas-kidney transplantation: comparison of two maintenance immunosuppression protocols: tacrolimus/mycophenolate mofetil versus tacrolimus/sirolimus. Transplantation. 2002;73:169–77.
Vincenti F, Luggen M. T cell costimulation: a rational target in the therapeutic armamentarium for autoimmune diseases and transplantation. Annu Rev Med. 2007;58:347–58.
Martin ST, Tichy EM, Gabardi S. Belatacept: a novel biologic for maintenance immunosuppression after renal transplantation. Pharmacotherapy. 2011;31:394–407.
Vincenti F, Charpentier B, Vanrenterghem Y, et al. A phase III study of belatacept-based immunosuppression regimens versus cyclosporine in renal transplant recipients (BENEFIT study). Am J Transplant. 2010;10:535–46.
Durrbach A, Pestana JM, Pearson T, et al. A phase III study of Belatacept versus cyclosporine in kidney transplants from extended criteria donors (BENEFIT-EXT study). Am J Transplant. 2010;10:547–57.
Levine MH, Abt PL. Treatment options and strategies for antibody mediated rejection after renal transplantation. Semin Immunol. 2012;24:136–42.
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Lockridge, J., Olyaei, A. (2019). Kidney Transplant-Immunosuppression and Rejection. In: Parajuli, S., Aziz, F. (eds) Kidney Transplant Management. Springer, Cham. https://doi.org/10.1007/978-3-030-00132-2_4
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DOI: https://doi.org/10.1007/978-3-030-00132-2_4
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