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Immunosuppression: Induction, Maintenance, and Steroid Avoidance Protocols

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  • First Online:
Solid Organ Transplantation in Infants and Children

Part of the book series: Organ and Tissue Transplantation ((OTT))

  • 169 Accesses

Abstract

During the past 50 years, kidney transplantation has become an increasingly successful form of renal replacement therapy, as demonstrated, in particular, by the dramatic improvements in 1-year patient and allograft survival rates. These have improved to over 90 % for both deceased and living donor allografts, and acute rejection rates have decreased to approximately 10 % at 1 year. To a great extent, this improvement correlates with the availability of a greater number of more effective immunosuppressive medications and, for selected drugs, the availability of therapeutic drug monitoring. Currently nearly two-thirds of all recipients receive some form of induction therapy at the time of transplantation and then remain on a maintenance regimen of two or three medications. The combinations of drugs that are currently available can be adjusted to allow the therapy to be individualized between patients to deliver adequate immunosuppression while minimizing side effects and maximizing both patient and graft survival.

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Abbreviations

APC:

Antigen-presenting cell

ATG:

Antithymocyte globulin

AZA:

Azathioprine

CMV:

Cytomegalovirus

CNI:

Calcineurin inhibitors

CS:

Corticosteroids

CsA:

Cyclosporine A

DSA:

Donor-specific antibodies

EBV:

Epstein-Barr virus

eGFR:

Estimated or calculated glomerular filtration rate

EVL:

Everolimus

HLA:

Major histocompatibility complex antigens

IL-2 RA:

Interleukin-2 receptor antagonist

KDIGO:

Kidney disease improving global outcome

mGFR:

Measured glomerular filtration rate

MMF:

Mycophenolate mofetil

mTOR:

Mammalian target of rapamycin

mTORi:

Mammalian target of rapamycin inhibitor

PRA:

Panel reactive antibodies

PTLD:

Posttransplant lymphoproliferative disorder

r-ATG:

Rabbit ATG (antithymocyte globulin), thymoglobulin

SRL:

Sirolimus

TAC:

Tacrolimus

TCR:

T-cell receptor complex

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Authors and Affiliations

  1. Division of Solid Organ Transplantation, Emeritus, Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Bruce A. Kaiser

  2. Global Clinical Research, Immunology, Bristol-Myers Squibb, Pharmaceutical Research Institiute, Princeton, NJ, USA

    Martin S. Polinsky

Authors
  1. Bruce A. Kaiser
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  2. Martin S. Polinsky
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Correspondence to Bruce A. Kaiser or Martin S. Polinsky .

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Editors and Affiliations

  1. Jefferson Medical College, AI Dupont Hospital for Children Department of Surgery, Wilmington, Delaware, USA

    Stephen P. Dunn

  2. Liver & Intestine Transplantation, Seattle Children’s Hospital Liver & Intestine Transplantation, Seattle, Washington, USA

    Simon Horslen

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Kaiser, B.A., Polinsky, M.S. (2016). Immunosuppression: Induction, Maintenance, and Steroid Avoidance Protocols. In: Dunn, S., Horslen, S. (eds) Solid Organ Transplantation in Infants and Children. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-08049-9_32-1

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