Abstract
Five decades of clinical transplantation have seen a dramatic improvement in many aspects of patient outcome, largely attributable to better quality immunosuppressive agents and their more judicious use. The success of contemporary immunosuppression is underscored by a reduction in the incidence of acute rejection rates between 1988 and 1998 from 60 to 20 percent and an improvement in one-year renal allograft survival rates to around 90 percent over the past 2 decades [1],[2]. Over the same period, despite substantial evidence implicating acute rejection as a major risk factor for chronic allograft nephropathy, the early benefits of our current immunosuppressive agents have not been maintained in the long-term. Historically, the immunosuppressive arsenal has encompassed predominantly steroid-based therapy initially and subsequently, the introduction of antimetabolites, calcineurin phosphatase inhibition, as well as antilymphocyte antibodies. Most of these agents are broadly acting and non-specific in their immunosuppressive effect. Consequently, these drugs have been associated with the spectrum of risks of global over-immunosuppression, including the development of life-threatening infectious complications and the increased risk of certain malignancies. Besides risk related to excessive immunosuppression, these medications have all been implicated in the plethora of serious non-immune related adverse effects, including perturbations in metabolic pathways (diabetes mellitus, osteopenia, hyperlipidemia), renal function (renal failure, hypertension), as well as several cosmetically disfiguring manifestations (weight gain, skin friability and bruising, hirsutism and alopecia).
Keywords
- Acute Rejection
- Renal Allograft
- Cardiac Allograft
- Clinical Transplantation
- Chronic Allograft Nephropathy
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Bloom, R.D., Turka, L.A. (2001). Costimulation Blockade. In: Sayegh, M.H., Remuzzi, G. (eds) Current and Future Immunosuppressive Therapies Following Transplantation. Springer, Dordrecht. https://doi.org/10.1007/978-94-010-1005-4_15
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DOI: https://doi.org/10.1007/978-94-010-1005-4_15
Publisher Name: Springer, Dordrecht
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