Immunosuppressive medications for renal transplantation: A multiple choice question

Abstract

loci. Donor-specific T-cell cytotoxic crossmatch was strongly positive, and the kidney was declined. The following month, she was admitted to the hospital with an episode of staphylococcal line sepsis, treated with a course of vancomycin.Four months later, a zero-HLA-mismatched kidney was offered to her via the United Network for Organ Sharing (UNOS) six-antigen-match program. The donor, a resident of Maryland, was a 61-year-old victim of a cerebrovascular accident and had a five-year history of treated hypertension. The donor's serum creatinine at the time of harvesting was 1.4 mg/dL after reaching a post-admission peak of 2.2 mg/dL. A renal biopsy performed at the time of harvesting showed 8 of 50 totally sclerosed glomeruli and "minimal" interstitial atrophy. Both standard T-cell cytotoxic and flow cytometry crossmatching were negative. Both the donor and recipient were positive for cytomegalovirus antibody. After a discussion with the patient and her nephrologist

Role of Maintenance Immunosuppressive Regimen in Kidney Transplant Outcome

“…The immunosuppressive regimen that provides the best long-term outcome has yet to be defined. There are multiple factors to consider when choosing a maintenance immunosuppressive regimen, including the adverse-effect profile, cost, potency, and effect on allograft function (23). Because of the short-term outcomes and the low power of trials for new immunosuppressants, there is little information about the longterm graft outcomes that are associated with the various maintenance immunosuppressant regimens (24).…”

The effect of maintenance immunosuppression medication on the change in kidney allograft function

“…A number of factors, including the potency of immunosuppression, side effect profile, cost, and the effect on allograft function should be considered when choosing one maintenance immunosuppression medication over another [13]. Prospective trials of new immunosuppression medications were designed to show differences in short-term outcomes, but were not powered to show differences in long-term allograft survival.…”

FTY720-induced lymphocyte homing modulates post-transplant preservation/reperfusion injury

“…Grafts that fail to function immediately are more susceptible to acute rejection and earlier onset of chronic allograft nephropathy [1]. Although currently used immunosuppressive agents safely reduce the incidence of acute rejection episodes, there is no protocol currently available to ameliorate early and late consequences of I/RI [2]. FTY720 is a new immunomodulator that initiates sequestration of lymphocytes to secondary lymphoid organs and reduces the number of circulatory lymphocytes [3].…”