Immunosuppression in kidney transplantation

Hricik DE. Steroid-free immunosuppression in kidney transplantation an editorial review. Am J Transplant 2002 2(l) 19-24. 

Schulak JA. 2004. The steroid immunosuppression in kidney transplantation A passing era. J Surg Res. 117 154-162. 

Rapomycin which is a target for immunosuppression in kidney transplantation with... 

Samaniego M, Becker BN, Djamali A (2006). Drug insight Maintenance immunosuppression in kidney transplant recipients. Nat Clin Pr-act Nephrol 2 688-699. 

Houde I, Isenring P, Boucher D, Noel R, Lachanche JG. Mycophenolate mofetil, an alternative to cyclosporine A for long-term immunosuppression in kidney transplantation Transplantation 2000 70(8) 1251-3. 

Wong W, Venetz JP, Tolkoff-Rubin N, Pascual M. 2005 immunosuppressive strategies in kidney transplantation which role for the calcineurin inhibitors Transplantation. 2005 80 289-296. 

Shield CF III, McGrath MM, Goss TF. Assessment of health-related quality of life in kidney transplant patients receiving tacrolimus (FK506)-based versus cyclosporine-based immunosuppression. FK506 Kidney Transplant Study Group. Transplantation 1997 64(12) 1738-43. 

Pescovitz MD, Govani M. Sirolimus and mycophenolate mofetil for calcineurin-free immunosuppression in renal transplant recipients. Am J Kidney Dis 2001 38 S16-S21. 

Holt DW. Therapeutic di ug monitoring of immunosuppressive drugs in kidney transplantation. Curr Opin Nephrol Hypertens 2002 11 657-63. 

The potency and effectiveness of TAC have prompted studies to investigate withdrawal of corticosteroids or other concomitant immunosuppressants. A large randomized, controlled trial compared triple-drug therapy, consisting of TAC, corticosteroids, and mycophe-nolate mofetil, with early withdrawal of corticosteroids or mycophe-nolate in kidney transplant recipients. The results demonstrated equal efficacy in the three arms with no difference in acute rejection rates after 6 months of therapy. Furthermore, TAC has demonstrated equal efficacy to CSA, each in combination with azathioprine, with regard to corticosteroid withdrawal. ... 

Salles MJ, Sens YA, Boas LS, Machado CM. Influenza virus vaccination in kidney transplant recipients serum antibody response to different immunosuppressive drugs. Clin Transplant 2010 24(1) E17-23. 

The introduction of PP2B (calcinemin) inhibitors revolutionized kidney transplantation. Cyclosporine A and tacrolimus (FK506) are the principal immunosuppressants prescribed for adult and pediatric renal transplantation. Cyclosporine A was in use clinically long before its mechanism of action was elucidated. 

Cyclosporine and tacrolimus are calcineurin inhibitors that are administered as part of immunosuppressive regimens in kidney, liver, heart, lung, and bone marrow transplant recipients. In addition, they are used in autoimmune disorders such as psoriasis and multiple sclerosis. The pathophysiologic mechanism for ARF is renal vascular vasoconstriction.41 It often occurs within the first 6 to 12 months of treatment, and can be reversible with dose reduction or drug discontinuation. Risk factors include high dose, elevated trough blood concentrations, increased age, and concomitant therapy with other nephrotoxic drugs.41 Cyclosporine and tacrolimus are extensively metabolized by... 

Joseph Murray performed the first successful organ transplant in 1954, a kidney transplant between identical twins.1 This was a success in large part because no immunosuppression was necessary since the donor and recipient were genetically identical. Murray s success led to attempts with other organs over the next 20 years (Table 52-1). 

The induction agents are highly immunosuppressive and, when given prior to some organ transplants (e.g., kidney transplant), allow for significant reductions in acute rejection... 

Infectious disease studies are normally conducted over a short time, providing only snapshots and do not provide information on the consequence of chronic immunosuppression. The adverse health effects of chronic, low level immunosuppression have been addressed to some extent in transplant patients, primarily kidney transplants, who demonstrate an increase frequency of certain immunogenic tumors. 

Allogeneic transplants For prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants. Gengraf and A/eora/have been used in combination with azathioprine and corticosteroids. Sanc//n n nne always is to be used with adrenal corticosteroids. Sandimmune a so may be used in the treatment of chronic rejection in patients previously treated with other immunosuppressive agents. Because of the risk of anaphylaxis, reserve Sandimmune injection for patients who are unable to... 

The islet cells transplanted into humans are obtained from pancreatic tissue of deceased human donors (Figure 8.9). Implantation of these cells in recipients displaying a competent immune system would, at best, be of transient therapeutic benefit. The ensuing immune response would quickly destroy the foreign cells. Studies conducted thus far in humans have utilized diabetic patients who have received kidney transplants, as these are already subject to immunosuppressive therapy. However, a major stumbling block to the widespread adoption of this therapeutic approach is, predictably, the requirement to induce concurrent immune suppression. 

It is recently approved for immunosuppression in liver and kidney transplant patients. 

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