title: Drug insight: maintenance immunosuppression in kidney transplant recipients.
abstract: Kidney transplantation is the treatment of choice for patients with end-stage renal disease, in part because of ongoing efforts towards improving immunosuppressive strategies. Although calcineurin inhibitors remain the mainstay of immunosuppression in kidney transplant recipients, within this class of drug there has been a shift from use of ciclosporin to use of tacrolimus. Mycophenolate mofetil and mycophenolate sodium are now the antimetabolites of choice. A new class of drugs (inhibitors of mammalian target of rapamycin) that includes sirolimus is being increasingly used in stable kidney transplant recipients. New data, however, indicate that a more cautious approach to the use of this drug is warranted. Many transplant centers are now using steroid avoidance, minimization and withdrawal protocols. The impact of these different drugs and therapeutic strategies on outcomes has to be weighed against their immunosuppressive benefit. As more and more community-based nephrologists and primary care physicians are becoming involved in the care of stable kidney transplant recipients, it is important for these clinicians to familiarize themselves with novel immunosuppressive drugs and their pharmacokinetic properties.
authors.affiliation: Nephrology Section, Department of Medicine, University of Wisconsin Madison, 3034 Fish Hatchery Road, Suite B, Madison, WI 53713, USA.
authors.forename: Millie
authors.initials: M
authors.lastname: Samaniego
authors.forename: Bryan N
authors.initials: BN
authors.lastname: Becker
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
mesh_terms: D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation
chemical_list: D007166:Immunosuppressive Agents