Strategies for minimizing immunosuppression in kidney transplantation.
Immunosuppression remains the cause of most morbidity following organ transplantation. However, its use is also responsible for the outstanding graft and patient survival rates commonplace in modern transplantation. Thus, the predominant challenge for transplant clinicians is to provide a level of immunosuppression that prevents graft rejection while preserving immunocompetence against environmental pathogens. This review will outline several strategies for minimizing or tailoring the use of immunosuppressive drugs. The arguments for various strategies will be based on clinical trial data rather than animal studies. A distinction will be made between conventional immunosuppressive drug reduction based on over-immunosuppression, and newer induction methods specifically designed to lessen the need for chronic immunosuppression. Based on the available data we suggest that most patients can be transplanted with less immunosuppression than is currently standard.
Kirk
Allan D
AD
Transplantation Branch, Department of Health and Human Services, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Center Drive, Bethesda, MD 20892, USA. allank@intra.niddk.nih.gov
Mannon
Roslyn B
RB
Swanson
S John
SJ
Hale
Douglas A
DA
D004305:Dose-Response Relationship, Drug; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology; D020123:Sirolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D020123:Sirolimus