Current Status Regarding Immunosuppressive Treatment in Patients after Renal Transplantation

Abstract

Renal transplantation is now the best treatment for end-stage renal failure. To avoid rejection and prolong graft function, organ recipients need immunosuppressive therapy. The immunosuppressive drugs used depends on many factors, including time since transplantation (induction or maintenance), aetiology of the disease, and/or condition of the graft. Immunosuppressive treatment needs to be personalised, and hospitals and clinics have differing protocols and preparations depending on experience. Renal transplant recipient maintenance treatment is mostly based on triple-drug therapy containing calcineurin inhibitors, corticosteroids, and antiproliferative drugs. In addition to the desired effect, the use of immunosuppressive drugs carries risks of certain side effects. Therefore, new immunosuppressive drugs and immunosuppressive protocols are being sought that exert fewer side effects, which could maximise efficacy and reduce toxicity and, in this way, reduce both morbidity and mortality, as well as increase opportunities to modify individual immunosuppression for renal recipients of all ages. The aim of the current review is to describe the classes of immunosuppressive drugs and their mode of action, which are divided by induction and maintenance treatment. An additional aspect of the current review is a description of immune system activity modulation by the drugs used in renal transplant recipients. Complications associated with the use of immunosuppressive drugs and other immunosuppressive treatment options used in kidney transplant recipients have also been described.

Exploring Costimulatory Blockade-Based Immunologic Strategies in Transplantation: Are They a Promising Immunomodulatory Approach for Organ and Vascularized Composite Allotransplantation?

“…Immunosuppressants have been documented to increase the risk of malignancy and opportunistic infection; therefore, regimens must be balanced to prevent both rejection and agent-induced complications. Therapies have improved over the last three decades, with, however, no one-size-fits-all strategy for transplanted patients, the choice of regimen protocol depending on the type of organ, expertise, patient compliance and the ability to afford additional expenses, as well as individual particularities [ 125 , 126 , 127 , 128 ].…”

“…However, a biopsy is the investigation that ensures a definitive diagnosis. If confirmed, treatment is adjusted based on severity, using high-dose corticosteroids in mild to moderate cases [ 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 ]. Anti-thymocyte globulin may be used as a rescue strategy in corticosteroid-resistant or severe rejections [ 133 ].…”

“…Anti-thymocyte globulin may be used as a rescue strategy in corticosteroid-resistant or severe rejections [ 133 ]. Figure 2 summarizes the immunosuppressive therapeutic strategies in organ transplantation [ 125 , 126 , 127 , 128 , 134 , 135 , 136 , 137 , 138 , 139 , 140 ].…”

“…Anti-thymocyte globulin may be used as a rescue strategy in corticosteroid-resistant or severe rejections [133]. Figure 2 summarizes the immunosuppressive therapeutic strategies in organ transplantation [125][126][127][128][134][135][136][137][138][139][140]. Even more so in the case of vascularized composite transplants, which are not life-saving but have a functional indication, the immunosuppressive treatment must be carefully selected and managed to minimize the occurrence of severe adverse reactions [15,121].…”