Skip to main content

Kidney Transplant-Immunosuppression and Rejection

  • Chapter
  • First Online:
Kidney Transplant Management
  • 1200 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hardinger KL, Koch MJ, Brennan DC. Current and future immunosuppressive strategies in renal transplantation. Pharmacotherapy. 2004;24:1159–76.

    Article  CAS  Google Scholar 

  2. Hardinger KL. Selection of induction therapy. Transpl Int. 2013;26:662–72.

    Article  CAS  Google Scholar 

  3. Gabardi S, Martin ST, Roberts KL, Grafals M. Induction immunosuppressive therapies in renal transplantation. Am J Health Syst Pharm. 2011;68:211–8.

    Article  CAS  Google Scholar 

  4. Kahan BD. Reduction of the occurrence of acute cellular rejection. Transplantation. 1999;67:276–84.

    Article  CAS  Google Scholar 

  5. Nashan B. Antibody induction therapy in renal transplant patients receiving calcineurin-inhibitor immunosuppressive regimens: a comparative review. BioDrugs. 2005;19:39–46.

    Article  CAS  Google Scholar 

  6. 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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  8. Hanaway MJ, Woodle ES, Mulgaonkar S, et al. Alemtuzumab induction in renal transplantation. N Engl J Med. 2011;364:1909–19.

    Article  CAS  Google Scholar 

  9. 3C Study Collaborative Group. Alemtuzumab – based induction treatment versus basiliximab – based induction treatment in kidney transplantation. Lancet. 2014;384:1684–90.

    Article  Google Scholar 

  10. Bustami RT. Immunosuppression and the risk of post transplant malignancy. Am J Trans. 2004;4:87–93.

    Article  Google Scholar 

  11. Caillard S. Posttransplant Lymphoproferative disorders. Transplantation. 2005;80:1233–43.

    Article  CAS  Google Scholar 

  12. Kauffman HM, et al. Post-transplant de novo malignancies in renal transplant recipients: the past and present. Transplant Int. 2006;19(8):607–20.

    Article  Google Scholar 

  13. Hall EC, et al. Association of Antibody Induction immunosuppression with cancer. Transplantation. 2015;99:5.

    Article  Google Scholar 

  14. 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.

    PubMed  Google Scholar 

  15. Golshayan D, Buhler L, Lechler RI, Pascual M. From current immunosuppressive strategies to clinical tolerance of allografts. Transpl Int. 2007;20:12–24.

    Article  CAS  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. 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.

    Article  CAS  Google Scholar 

  19. Azzi JR. Calcineurin inhibitors: 40 years later. J Immunol. 2013;191(12):5785–91.

    Article  CAS  Google Scholar 

  20. Gabardi S, Tran JL, Clarkson MR. Enteric-coated mycophenolate sodium. Ann Pharmacother. 2003;37:1685–93.

    Article  CAS  Google Scholar 

  21. Budde K, Durr M, Liefeldt L, Neumayer HH, Glander P. Enteric-coated mycophenolate sodium. Expert Opin Drug Saf. 2010;9:981–94.

    Article  CAS  Google Scholar 

  22. Augustine JJ, Bodziak KA, Hricik DE. Use of sirolimus in solid organ transplantation. Drugs. 2007;67:369–91.

    Article  CAS  Google Scholar 

  23. 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.

    Article  CAS  Google Scholar 

  24. 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.

    Article  CAS  Google Scholar 

  25. 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.

    Article  CAS  Google Scholar 

  26. 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.

    Article  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. 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.

    Article  CAS  Google Scholar 

  29. 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.

    Article  CAS  Google Scholar 

  30. Martin ST, Tichy EM, Gabardi S. Belatacept: a novel biologic for maintenance immunosuppression after renal transplantation. Pharmacotherapy. 2011;31:394–407.

    Article  CAS  Google Scholar 

  31. 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.

    Article  CAS  Google Scholar 

  32. 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.

    Article  CAS  Google Scholar 

  33. Levine MH, Abt PL. Treatment options and strategies for antibody mediated rejection after renal transplantation. Semin Immunol. 2012;24:136–42.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joe Lockridge .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

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

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-00132-2_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-00131-5

  • Online ISBN: 978-3-030-00132-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics